Provider Demographics
NPI:1316590714
Name:RICHARDS, BRENDA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:BAINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74013-0825
Mailing Address - Country:US
Mailing Address - Phone:918-261-4053
Mailing Address - Fax:
Practice Address - Street 1:ECLIPSE MENTAL HEALTH SERVICES
Practice Address - Street 2:817 S. ELM PL., SUITE C
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012
Practice Address - Country:US
Practice Address - Phone:918-940-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109700163WG0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice