Active NPI
Kelley Grayson Brenner, PA-C
- Medical Physician Assistant
- Saint Cloud, FL
National Provider Identifier
1689843054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-9107363
- Practice address
- 3100 17TH St
Saint Cloud, FL 34769-6021 - Phone
- (407) 891-3500
- Fax
- (407) 892-3285
- NPI assigned
- Feb 29, 2008
- Last updated
- Feb 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110002724 | VA | |
| Medical Physician Assistant | 363AM0700X | 0110002724 | VA | |
| Medical Physician Assistant | 363AM0700X | PA-9107363 | FL | Primary |
Addresses
Primary practice location
3100 17TH St
Saint Cloud, FL 34769-6021
Mailing address
3100 17TH St
Saint Cloud, FL 34769-6021
Phone (407) 891-3500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-9107363 | FL | MD | Medical Physician Assistant |
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Interoperability endpoints
- kelley.brenner@sl.eclinicaldirectplus.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba ProHealth Family Physicians
- Family Medicine Physician
- Saint Cloud, FL
- NPI 1336189190
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454371200000",
"number": "1689843054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 17TH ST",
"city": "SAINT CLOUD",
"state": "FL",
"postal_code": "347696021",
"telephone_number": "407-891-3500",
"fax_number": "407-892-3285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 17TH ST",
"city": "SAINT CLOUD",
"state": "FL",
"postal_code": "347696021",
"telephone_number": "407-891-3500",
"fax_number": "407-892-3285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNER",
"first_name": "KELLEY",
"middle_name": "GRAYSON",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-29",
"last_updated": "2016-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110002724",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "VA",
"license": "0110002724",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA-9107363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.