Provider Demographics
NPI:1225098460
Name:HUENERGARDT, BRENDA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KAY
Last Name:HUENERGARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3046
Mailing Address - Country:US
Mailing Address - Phone:580-571-8009
Mailing Address - Fax:580-571-8032
Practice Address - Street 1:1650 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3046
Practice Address - Country:US
Practice Address - Phone:580-571-8009
Practice Address - Fax:580-571-8032
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK22843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH67048Medicare UPIN