Active NPI
Kevin Francis Brennan, FNP-C
- Community Health Nurse Practitioner
- Watertown, NY
National Provider Identifier
1295828879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Nurse Practitioner
- License
- 32 320050
- Practice address
- 218 Stone St
Watertown, NY 13601 - Phone
- (315) 782-7400
- Fax
- (315) 782-7460
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Nurse Practitioner | 363LC1500X | 32 320050 | NY | Primary |
Addresses
Primary practice location
218 Stone St
Watertown, NY 13601
Mailing address
Red Lake Hospital
PO Box 497, Highway 1
Red Lake, MN 56671
Phone (218) 679-3912
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807 | Other | AK | STATE LICENSE |
Other names 1
- Kevin F Brennan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32 320050 | NY | MD | Community Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PHS Indian Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Red Lake, MN
- NPI 1508809765
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314662400000",
"number": "1295828879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RED LAKE HOSPITAL",
"address_2": "PO BOX 497, HIGHWAY 1",
"city": "RED LAKE",
"state": "MN",
"postal_code": "56671",
"telephone_number": "218-679-3912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 STONE ST",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "13601",
"telephone_number": "315-782-7400",
"fax_number": "315-782-7460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "KEVIN",
"middle_name": "FRANCIS",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2011-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LC1500X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Community Health",
"state": "NY",
"license": "32 320050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "807",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KEVIN",
"last_name": "BRENNAN",
"middle_name": "F",
"credential": "FNP-C",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.