Provider Demographics
NPI:1477055234
Name:TAYLOR, BRENDA BELLEDEAN (MASTERS DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:BELLEDEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472365 E 1065 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7102
Mailing Address - Country:US
Mailing Address - Phone:918-774-4944
Mailing Address - Fax:
Practice Address - Street 1:1108 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2227
Practice Address - Country:US
Practice Address - Phone:918-775-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator