MEDICARE: MR. BRENT JOSEPH LANDKAMMER PMHNP-BC, ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60966969	WA

General Provider Information

NPI Number	:	1275535866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRENT JOSEPH LANDKAMMER PMHNP-BC, ARNP

Provider Business Mailing Address
First Line	:	1030 N CENTER PKWY STE N197
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-957-2130
Fax Number	:	509-957-2096

Provider Business Practice Location Address
First Line	:	1030 N CENTER PKWY STE N197
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7160
Country	:	US
Telephone Number	:	509-957-2130
Fax Number	:	509-957-2096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/14/2022

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