Provider Demographics
NPI:1740453299
Name:HARRISON, BRENDA KAYE (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAYE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:KAYE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:3702 FAIRHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4321
Mailing Address - Country:US
Mailing Address - Phone:432-260-2292
Mailing Address - Fax:
Practice Address - Street 1:4506 BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2642
Practice Address - Country:US
Practice Address - Phone:432-689-6818
Practice Address - Fax:432-689-6901
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX547131OtherMEDICAL LICENSE