Healthcare Provider Details

I. General information

NPI: 1487298725
Provider Name (Legal Business Name): BRIAN BRENNAN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 S GRAND BLVD
SAINT LOUIS MO
63111-2319
US

IV. Provider business mailing address

PO BOX 790379
SAINT LOUIS MO
63179-0379
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-0100
  • Fax:
Mailing address:
  • Phone: 314-652-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2019001501
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019001501
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2019001501
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: