Provider Demographics
NPI:1255413134
Name:MORGAN-WEBBER, BRENDA (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MORGAN-WEBBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8204
Mailing Address - Country:US
Mailing Address - Phone:903-535-9041
Mailing Address - Fax:
Practice Address - Street 1:214 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8131
Practice Address - Country:US
Practice Address - Phone:903-593-1892
Practice Address - Fax:903-533-1776
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP104123363LP0200X
TX578951363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117394002Medicaid
TX578951OtherLICENSE
TX45-2578435OtherTRICARE
TX8DK985OtherBCBS
TX117394005Medicaid
TX81N823OtherBCBS
TX8L26330Medicare Oscar/Certification
TX81N823Medicare ID - Type Unspecified
TX117394005Medicaid