Provider Demographics
NPI:1649381096
Name:HARKINS, BRENDA L (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:HARKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 LONE STAR RD STE 260
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8754
Mailing Address - Country:US
Mailing Address - Phone:682-341-7230
Mailing Address - Fax:682-341-7232
Practice Address - Street 1:2302 LONE STAR RD STE 260
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8754
Practice Address - Country:US
Practice Address - Phone:682-341-7230
Practice Address - Fax:682-341-7232
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9978207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030668003Medicaid
TX1P3607OtherMEDICARE
P00179744Medicare PIN