Provider Demographics
NPI:1053742783
Name:MASTIN, BRENDA (FNP)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:
Last Name:MASTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9188 PAMPAS CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-4213
Mailing Address - Country:US
Mailing Address - Phone:859-415-3099
Mailing Address - Fax:
Practice Address - Street 1:9188 PAMPAS CT
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-4213
Practice Address - Country:US
Practice Address - Phone:859-415-3099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily