1013959964 NPI number — MRS. BRENDA A. AUSTIN NP-C

Table of content: MRS. BRENDA A. AUSTIN NP-C (NPI 1013959964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013959964 NPI number — MRS. BRENDA A. AUSTIN NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN
Provider First Name:
BRENDA
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-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:
1013959964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3165 STILLWATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86305-7173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-442-5495
Provider Business Mailing Address Fax Number:
608-716-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3165 STILLWATER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305-7173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-277-0875
Provider Business Practice Location Address Fax Number:
608-716-2838
Provider Enumeration Date:
06/12/2006

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: 363LA2200X , with the licence number:  AP1721 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP1721 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1013959964 . This is a "INDIVIDUAL" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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