Provider Demographics
NPI:1023289717
Name:BRANDT, KASEY LIN (APRN)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:LIN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:LIN
Other - Last Name:GRIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1721 RIO RANCHO BLVD NW
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-896-8600
Mailing Address - Fax:505-896-8687
Practice Address - Street 1:16939 SW 134TH AVE
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-5413
Practice Address - Country:US
Practice Address - Phone:352-265-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCS00216645363LP0200X
NMCNP-01753363LP0200X
FLARNP9230919363LP0200X
FLAPRN9230919363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics