Provider Demographics
NPI:1265812424
Name:GAVIN, BRENDA FAYE (APRN FNP-C AG-ACNP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAYE
Last Name:GAVIN
Suffix:
Gender:F
Credentials:APRN FNP-C AG-ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 1A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1128
Practice Address - Country:US
Practice Address - Phone:251-343-6848
Practice Address - Fax:251-343-5708
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087281363LF0000X, 363LG0600X
MSR900157363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6858582OtherAETNA
MS08101023Medicaid
AL512-42739OtherBCBS
AL250441Medicaid
AL512-42738OtherBCBS
AL512-42741OtherBCBS
AL1265812424OtherHUMANA MILITARY
AL250364Medicaid
AL250414Medicaid
MS1265812424OtherMAGNOLIA HEALTH
AL250605Medicaid
AL512-42742OtherBCBS
AL5896052OtherUHC
ALA03966AOtherMEDICARE
ALZ27049OtherVIVA HEALTH