Provider Demographics
NPI:1659721090
Name:ARNOLD, BRENDA SUE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SUE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10409 SHADY PINE DR
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6527
Mailing Address - Country:US
Mailing Address - Phone:228-424-9321
Mailing Address - Fax:
Practice Address - Street 1:6900 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-2133
Practice Address - Country:US
Practice Address - Phone:228-818-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR871834363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health