Provider Demographics
NPI:1699816066
Name:STALLINGS, BRENDA SPARKS (RN)
Entity Type:Individual
Prefix:MR
First Name:BRENDA
Middle Name:SPARKS
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 CEDARHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8127
Mailing Address - Country:US
Mailing Address - Phone:325-942-9658
Mailing Address - Fax:
Practice Address - Street 1:3418 CEDARHILL DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8127
Practice Address - Country:US
Practice Address - Phone:325-942-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525425163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics