Provider Demographics
NPI:1568295830
Name:JENNINGS, BRANDON (FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22595 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-9524
Mailing Address - Country:US
Mailing Address - Phone:530-227-9264
Mailing Address - Fax:
Practice Address - Street 1:2425 SONOMA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3026
Practice Address - Country:US
Practice Address - Phone:530-241-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031813207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease