Provider Demographics
NPI:1194034553
Name:GILES, BRENNON E (NURSE PRACTIONER)
Entity type:Individual
Prefix:MR
First Name:BRENNON
Middle Name:E
Last Name:GILES
Suffix:
Gender:M
Credentials:NURSE PRACTIONER
Other - Prefix:MR
Other - First Name:BRENNON
Other - Middle Name:E
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTIONER
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8425
Mailing Address - Fax:740-356-1262
Practice Address - Street 1:8770 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1918
Practice Address - Country:US
Practice Address - Phone:740-356-4100
Practice Address - Fax:740-355-4182
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.11807363LP0808X
OH11807363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health