Provider Demographics
NPI:1114013083
Name:PAINTER, BRENDA KAY (FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:PAINTER
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 1:8695 W JACK CARNES WAY
Mailing Address - Street 2:
Mailing Address - City:FRENCH LICK
Mailing Address - State:IN
Mailing Address - Zip Code:47432-1302
Mailing Address - Country:US
Mailing Address - Phone:812-936-3900
Mailing Address - Fax:812-936-3904
Practice Address - Street 1:8163 W STATE ROAD 56 STE A
Practice Address - Street 2:
Practice Address - City:WEST BADEN SPRINGS
Practice Address - State:IN
Practice Address - Zip Code:47469-7706
Practice Address - Country:US
Practice Address - Phone:812-723-7125
Practice Address - Fax:812-936-2599
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001773A363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200106900Medicaid
INQ28880Medicare UPIN
IN200106900Medicaid