Healthcare Provider Details

I. General information

NPI: 1598681744
Provider Name (Legal Business Name): KAITLYN MARIE BRANNIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 OCEAN HWY E
LELAND NC
28451-7867
US

IV. Provider business mailing address

273 LODER AVE
WILMINGTON NC
28409-4339
US

V. Phone/Fax

Practice location:
  • Phone: 910-371-0404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: