Provider Demographics
NPI:1326563008
Name:WASHINGTON, BRENDA DENISE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:DENISE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:DENISE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA/HHP
Mailing Address - Street 1:4813 TRAIL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-1233
Mailing Address - Country:US
Mailing Address - Phone:817-902-3631
Mailing Address - Fax:
Practice Address - Street 1:4813 TRAIL LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-1233
Practice Address - Country:US
Practice Address - Phone:817-902-3631
Practice Address - Fax:817-902-3631
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251G00000X, 261QM0850X, 372500000X, 251S00000X, 261QC1500X, 3747A0650X, 3747P1801X, 390200000X, 253Z00000X
TXNA609610372600000X, 373H00000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No372500000XNursing Service Related ProvidersChore Provider
No251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty