Individual
DR. BRENDEN KOOTSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
86 HARRIS RD, KILMARNOCK, VA 22482
(804) 435-1152
(804) 434-8080
Mailing address
86 HARRIS RD, KILMARNOCK, VA 22482-3845
(804) 435-1152
(804) 435-8080
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101264322
VA
208000000X
Pediatrics Physician
52671
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2012
Last updated
08/07/2018
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