Provider Demographics
NPI:1730942285
Name:BRANDT, KRISTIN JOLENE (APP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOLENE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:APP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:NE
Mailing Address - Zip Code:68864-0145
Mailing Address - Country:US
Mailing Address - Phone:605-520-2337
Mailing Address - Fax:
Practice Address - Street 1:908 N HOWARD AVE STE 108
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3529
Practice Address - Country:US
Practice Address - Phone:308-398-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115143363L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner