Healthcare Provider Details

I. General information

NPI: 1427236975
Provider Name (Legal Business Name): KATHLEEN MARY OBRIEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W PLUMB LN # B245
RENO NV
89509-3468
US

IV. Provider business mailing address

550 W PLUMB LN # B245
RENO NV
89509-3468
US

V. Phone/Fax

Practice location:
  • Phone: 508-769-3310
  • Fax:
Mailing address:
  • Phone: 508-769-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number254591
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number77459
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17437
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA134513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: