1164962460 NPI number — MRS. BRENDA DARLENE ELLEDGE M.ED, L.P.C.-S

Table of content: NANCY LYNN RANFT OTR (NPI 1760694509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164962460 NPI number — MRS. BRENDA DARLENE ELLEDGE M.ED, L.P.C.-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLEDGE
Provider First Name:
BRENDA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, L.P.C.-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESPARZA
Provider Other First Name:
BRENDA
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164962460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 PEBBLEBROOK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENN HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
328 PEBBLEBROOK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENN HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-268-3096
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2017

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: 101YM0800X , with the licence number:  16976 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com