Pamela Kelly Brennan

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

686650 Issued in TX

Practice address

208 Cibolo Ridge Trail
Boerne, TX 78015

Phone

(210) 269-8115

NPI assigned

Aug 29, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Pamela Jane Kelly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1831448448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 CIBOLO RIDGE TRAIL",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78015",
            "telephone_number": "210-269-8115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 CIBOLO RIDGE TRAIL",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "78015",
            "telephone_number": "210-269-8115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "PAMELA",
        "middle_name": "KELLY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "TX",
            "license": "686650",
            "primary": true
        },
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "VA",
            "license": "103-20123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "KELLY",
            "middle_name": "JANE",
            "credential": "IBCLC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kaytha Grace Bragg, LPC ASSOCIATE, LCDC
• Branding Hearts Home Health, LLC
• Brenna Lynn Brannen, PTA
• Liliana Bratton, LVN
• Jacob Lewis Brennan
• Alexis Payton Brewer, RBT
• Justin Bridges, PT, DPT
• Taylor Brinegar, LVN
• Susan Lynn Brintnall, RN
• Eddie Lee Brown, R.PH

• All providers in Boerne, TX
• Lactation Consultant (Registered Nurse) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.