Provider Demographics
NPI:1649207887
Name:HARRIS, BRENDA (ANP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:908 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2307
Mailing Address - Country:US
Mailing Address - Phone:580-254-3396
Mailing Address - Fax:580-256-1731
Practice Address - Street 1:908 19TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2307
Practice Address - Country:US
Practice Address - Phone:580-254-3396
Practice Address - Fax:580-256-1731
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0047494363LF0000X
OK47494363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100146050Medicaid
S42605Medicare UPIN
OK100146050Medicaid
OKP00658491Medicare PIN
OKOK401261Medicare PIN