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NPI Code Detail

MEDICARE: KATHLEEN GRENNAN CNM, APRN

MEDICARE: KATHLEEN GRENNAN CNM, APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1176B00000XMidwife99214TX
2374J00000XDoula
3367A00000XAdvanced Practice MidwifeTX

General Provider Information

NPI Number : 1770857559
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN GRENNAN CNM, APRN
Provider Business Mailing Address
First Line : 12240 LAMINGTON DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-7563
Country : US
Telephone Number : 817-789-2088
Fax Number :
Provider Business Practice Location Address
First Line : 622 HEMPHILL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3179
Country : US
Telephone Number : 817-878-2737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2012
Last Update Date : 09/19/2023

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