Provider Demographics
NPI:1972603579
Name:HALE, BRENDA C (PAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:HALE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-793-8869
Mailing Address - Fax:806-793-0043
Practice Address - Street 1:2002 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-793-8869
Practice Address - Fax:806-793-0043
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00271685OtherRAILROAD MEDICARE
8G0289Medicare PIN
Q54133Medicare UPIN