1316926991 NPI number — BRENDA LOUISE PURSLEY RPA-C

Table of content: BRENDA LOUISE PURSLEY RPA-C (NPI 1316926991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316926991 NPI number — BRENDA LOUISE PURSLEY RPA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURSLEY
Provider First Name:
BRENDA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316926991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 W 7TH ST
Provider Second Line Business Mailing Address:
PO BOX 564
Provider Business Mailing Address City Name:
COFFEYVILLE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67337-4954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-251-1100
Provider Business Mailing Address Fax Number:
620-251-7466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COFFEYVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67337-4954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-251-1100
Provider Business Practice Location Address Fax Number:
620-251-7466
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  15-00687 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 970010390 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100199200A . This is a "OKLAHOMA MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100345380A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042391 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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