Provider Demographics
NPI: | 1336808799 |
---|---|
Name: | HENNING, BRENDA ANN (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | BRENDA |
Middle Name: | ANN |
Last Name: | HENNING |
Suffix: | |
Gender: | F |
Credentials: | APRN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 10431 SW 103RD CT |
Mailing Address - Street 2: | |
Mailing Address - City: | AUGUSTA |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 67010-7981 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 316-258-3219 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10431 SW 103RD CT |
Practice Address - Street 2: | |
Practice Address - City: | AUGUSTA |
Practice Address - State: | KS |
Practice Address - Zip Code: | 67010-7981 |
Practice Address - Country: | US |
Practice Address - Phone: | 316-258-3219 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2021-12-14 |
Last Update Date: | 2021-12-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 80437 | 363LA2200X, 363LP2300X, 363LG0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No | 363LG0600X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |