Provider Demographics
NPI:1770663361
Name:MOFFITT, BRENDA L (ARNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-3610
Mailing Address - Country:US
Mailing Address - Phone:620-245-9080
Mailing Address - Fax:
Practice Address - Street 1:400 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4144
Practice Address - Country:US
Practice Address - Phone:785-452-6860
Practice Address - Fax:785-452-7293
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74863364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist