Provider Demographics
NPI:1669430500
Name:JONES, BRENDA M (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:M
Other - Last Name:O'HARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1771 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-3096
Mailing Address - Country:US
Mailing Address - Phone:660-438-5193
Mailing Address - Fax:
Practice Address - Street 1:1238 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3157
Practice Address - Country:US
Practice Address - Phone:660-438-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN2005037273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
787E313Medicare ID - Type Unspecified
MOQ60359Medicare UPIN