Healthcare Provider Details

I. General information

NPI: 1487586822
Provider Name (Legal Business Name): BRENNA KALYN MEYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CARE WAY
FREDERICKSBURG VA
22401-8425
US

IV. Provider business mailing address

6036 ERINBLAIR LOOP
HAYMARKET VA
20169-2612
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3131
  • Fax: 540-374-3134
Mailing address:
  • Phone: 571-305-0396
  • Fax: 571-305-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110011997
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: