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General NPI Number Information
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NPI Number | 1487911095
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Entity Type | Individual
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Provider Name | BRENDEN KOOTSEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 86 HARRIS RD
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City | KILMARNOCK
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State | VA
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Zip | 22482
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Country | US
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Telephone | 804-435-1152
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Fax | 804-434-8080
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Provider Business Mailing Address
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Address Line | 86 HARRIS RD
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City | KILMARNOCK
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State | VA
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Zip | 22482-3845
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Country | US
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Telephone | 804-435-1152
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Fax | 804-435-8080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 52671
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101264322
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License Number State | VA
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