Provider Demographics
NPI:1164858767
Name:CLARKE, BRENDA KAY (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAY
Last Name:CLARKE
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:1301 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5205
Practice Address - Country:US
Practice Address - Phone:979-731-4520
Practice Address - Fax:979-731-4570
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX240095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-1715140OtherBRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
1497183883OtherST. JOSEPH HEALTH POINT BRYAN - FACILITY NPI