Provider Demographics
NPI:1467810077
Name:BRUNS, KATHRYN (CNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BRUNS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CALLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1140 S KNOXVILLE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2609
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:801 PRO DR STE D1
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3307
Practice Address - Country:US
Practice Address - Phone:419-586-6489
Practice Address - Fax:419-586-8506
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily