Provider Demographics
NPI:1225161805
Name:ROWE, BRENDA G (ANP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:G
Last Name:ROWE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 RIFE MEDICAL LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-3888
Mailing Address - Fax:479-338-4453
Practice Address - Street 1:2708 RIFE MEDICAL LN
Practice Address - Street 2:SUITE 210
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-3888
Practice Address - Fax:479-338-4453
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003195363L00000X
ARATP-000180363LC0200X
ARA03195363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200133590AMedicaid
MO834123693Medicare PIN
KS200546910AMedicaid
P00461885Medicare PIN
MO424025500Medicaid