Provider Demographics
NPI:1417944646
Name:POGUE, BRENDA K (ANP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:K
Last Name:POGUE
Suffix:
Gender:F
Credentials:ANP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8086
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-6649
Mailing Address - Fax:314-362-5282
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM CARDIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-1291
Practice Address - Fax:314-362-4278
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO103523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424895837Medicaid
MO424895803Medicaid
MO424895811Medicaid
MO424895837Medicaid
MO424895803Medicaid
MO000080606Medicare ID - Type UnspecifiedAREA 1