Provider Demographics
NPI:1164598942
Name:BUFFINGTON, BRENDA THERESA (MIDWIFE)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:THERESA
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 ASHLEY
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351
Mailing Address - Country:US
Mailing Address - Phone:409-739-3904
Mailing Address - Fax:936-328-5226
Practice Address - Street 1:203 N. JACKSON
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:409-739-3904
Practice Address - Fax:936-328-5226
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96152175M00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3648065Medicaid