Provider Demographics
NPI:1699150938
Name:KENNER KEEFE, BRANDY NICHOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICHOLE
Last Name:KENNER KEEFE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:NICHOLE
Other - Last Name:KENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:801 ALBANY ST FL G
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-3791
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVENUE
Practice Address - Street 2:SUITE 1400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8124
Practice Address - Fax:617-638-6424
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily