Provider Demographics
NPI:1265873319
Name:BRENNAN, KATIE LYNN
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:1211 ECHELON PL STE A
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7693
Mailing Address - Country:US
Mailing Address - Phone:406-370-2426
Mailing Address - Fax:
Practice Address - Street 1:1211 ECHELON PL STE A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7693
Practice Address - Country:US
Practice Address - Phone:406-461-0974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38733363LP2300X
MT100818208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty