Provider Demographics
NPI:1467100495
Name:AMOS, BRENDA S
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:AMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10819 SUMMER MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4047
Mailing Address - Country:US
Mailing Address - Phone:832-274-1710
Mailing Address - Fax:
Practice Address - Street 1:10819 SUMMER MEADOWS CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4047
Practice Address - Country:US
Practice Address - Phone:832-274-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082256373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87-3123082OtherBUSINESS NPI
TX87-3123082Medicaid