Healthcare Provider Details

I. General information

NPI: 1780939975
Provider Name (Legal Business Name): BRENDA KAYE MCKENNA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-783-4375
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-783-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number03131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: