Healthcare Provider Details

I. General information

NPI: 1952916827
Provider Name (Legal Business Name): KAITLYN BROOKS RENARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

1000 S 12TH ST
MURRAY KY
42071-9303
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9200
  • Fax:
Mailing address:
  • Phone: 270-759-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015072
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: