MS. KELLEY GRAYSON BRENNER (NPI# 1689843054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689843054 |
| Entity Type | Individual |
| Full Name | MS. KELLEY GRAYSON BRENNER |
| Credential | PA-C |
| Practice Address |
3100 17th St Saint Cloud FL 34769-6021 |
| Practice Telephone | 4078913500 |
| Practice Fax Number | 4078923285 |
| Mailing Telephone | 4078913500 |
| Mailing Fax Number | 4078923285 |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2016-02-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 0110002724 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-9107363 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
0110002724 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3100 17TH ST |
| City | SAINT CLOUD |
| State | FL |
| Zip Code | 34769-6021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417913591 | Christopher Baur | Family Medicine | 3100 17th St, Saint Cloud, FL 34769-6021 | 2006-04-26 |
| 1992263164 | Total Vitality Medical of Florida, LLC | Clinic/Center | 3100 17th St, Saint Cloud, FL 34769-6021 | 2019-03-06 |
| 1083138622 | Bethany Mcqueen | Nurse Practitioner | 3100 17th St, Saint Cloud, FL 34769-6021 | 2017-07-26 |
| 1134583404 | Nikole Stephens | Student in an Organized Health Care Education/Training Program | 3100 17th St, Saint Cloud, FL 34769-6021 | 2016-04-12 |
| 1558798090 | Ila Anita Morin | Physician Assistant | 3100 17th St, Saint Cloud, FL 34769-6021 | 2013-09-30 |
| 1063765774 | Sierra A Hobbs | Physician Assistant | 3100 17th St, Saint Cloud, FL 34769-6021 | 2012-10-18 |
| 1427308055 | Pro Health Mso, LLC | Health Maintenance Organization | 3100 17th St, Saint Cloud, FL 34769-6021 | 2012-09-11 |
| 1386891760 | Belinda Bernard Johnson | Family Medicine | 3100 17th St, Saint Cloud, FL 34769-6021 | 2008-08-27 |
| 1831220052 | Karl Schweinberg | Physician Assistant | 3100 17th St, Saint Cloud, FL 34769-6021 | 2007-03-08 |
| 1073600656 | Kimberly Rae Stein | Family Medicine | 3100 17th St, Saint Cloud, FL 34769-6021 | 2006-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053877506 | Premier Med Pa | Clinic/Center | 2906 17th St., St Cloud, FL 34769 | 2019-02-20 |
| 1760975387 | Mayra Rosado | Psychologist | Carrousel Therapy Center, 3201 Budinger Ave., Saint Cloud, FL 34769 | 2018-06-08 |
| 1598282113 | Salud Urgent Care LLC | Clinic/Center | 3107 13th Street, Saint Cloud, FL 34769 | 2017-08-24 |
| 1710332671 | American Healthcare Community Behavioral Services LLC | Social Worker | 1203 Florida Ave., St. Cloud, FL 34769 | 2016-04-28 |
| 1215395785 | Elite Garden | Assisted Living Facility | 4319 Neptune Road, St Cloud, FL 34769 | 2016-01-29 |
| 1336506732 | Adventist Health System/sunbelt, Inc. | Clinic/Center | 4660 13th Street, St. Cloud, FL 34769 | 2016-01-15 |
| 1306202064 | Megan Rose Mcclave | Registered Nurse | 524 13th Street, St. Cloud, FL 34769 | 2016-01-12 |
| 1821473133 | Angela Creager | Counselor | 446 Hamilton Park Circle, St. Cloud, FL 34769 | 2015-07-28 |
| 1730574906 | Jordico LLC | Assisted Living Facility | 4417 13th Street, Suite 142, Saint Cloud, FL 34769 | 2015-04-03 |
| 1255731667 | Judimar Rodriguez | Behavioral Analyst | 1605 Eastern Ave, Saint Cloud, FL 34769 | 2014-09-04 |
| Find all providers in zip 34769 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992944656 | Laura M Gunder Mcclary | Physician Assistant | 3301 Buckingham Way, Saint Cloud, FL 34772-8747 | 2009-02-19 |
| 1497360259 | David Scott Levy | Physician Assistant | 2029 Hickory Tree Rd, Saint Cloud, FL 34772-8906 | 2020-09-09 |
| 1164055505 | Anne Elizabeth Cullen | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2020-02-13 |
| 1770139420 | Maranda Kate Heinks | Physician Assistant | 1900 Centracare Cir Ste 2400, Saint Cloud, MN 56303-5000 | 2019-08-16 |
| 1063935955 | Amanda Marilyn Michalski | Physician Assistant | 1301 33rd St S, Saint Cloud, MN 56301-9668 | 2017-07-21 |
| 1336688175 | Courtney Mae Wittrock | Physician Assistant | 1900 Centracare Cir, Suite 2300, Saint Cloud, MN 56303-5000 | 2017-02-13 |
| 1558798090 | Ila Anita Morin | Physician Assistant | 3100 17th St, Saint Cloud, FL 34769-6021 | 2013-09-30 |
| 1063852085 | Dimitrios N Minadakis | Physician Assistant | 251 County Road 120, Saint Cloud, MN 56303-4872 | 2013-07-05 |
| 1063765774 | Sierra A Hobbs | Physician Assistant | 3100 17th St, Saint Cloud, FL 34769-6021 | 2012-10-18 |
| 1942589080 | Susan Michelle Luetmer | Physician Assistant | 3701 12th St N, Suite 100, Saint Cloud, MN 56303-2255 | 2011-08-08 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 34769 |
Please comment or provide details below to improve the information on MS. KELLEY GRAYSON BRENNER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.