Provider Demographics
NPI:1447877279
Name:O'BRYAN, KATHERINE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:O'BRYAN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4092 OLIVE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21758-9211
Mailing Address - Country:US
Mailing Address - Phone:404-446-8711
Mailing Address - Fax:
Practice Address - Street 1:1543 COUNTRY CLUB RD # A
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1306
Practice Address - Country:US
Practice Address - Phone:859-291-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-27
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204077363LA2200X
WV121482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health