Provider Demographics
NPI:1467455568
Name:DODDS, BRENDA K (RN, FNP-C, FNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:DODDS
Suffix:
Gender:F
Credentials:RN, FNP-C, FNP
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Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY, BUILDING A
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-886-7800
Mailing Address - Fax:660-886-3328
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY, BUILDING A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-886-7800
Practice Address - Fax:660-831-3328
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO092350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1085008Medicare PIN
Q40815Medicare UPIN
G80D666Medicare PIN