Provider Demographics
NPI:1184143794
Name:ALEXANDER, BRENDA JOYCE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 E LINWOOD BLVD STE 300D
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2142
Mailing Address - Country:US
Mailing Address - Phone:816-885-6812
Mailing Address - Fax:816-444-6336
Practice Address - Street 1:2420 E LINWOOD BLVD STE 300D
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2142
Practice Address - Country:US
Practice Address - Phone:816-885-6812
Practice Address - Fax:816-444-6336
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132296163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000Medicaid