Healthcare Provider Details

I. General information

NPI: 1841990603
Provider Name (Legal Business Name): KATHLEEN BRANDT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BRUCE ST
YREKA CA
96097-3474
US

IV. Provider business mailing address

PO BOX 1100
GUALALA CA
95445-1100
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-3507
  • Fax:
Mailing address:
  • Phone: 707-884-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95024536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: