Provider Demographics
NPI:1881909125
Name:THRASH, BRENDA (FNP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:THRASH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-9121
Mailing Address - Country:US
Mailing Address - Phone:601-656-8545
Mailing Address - Fax:601-656-3985
Practice Address - Street 1:1056 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-9121
Practice Address - Country:US
Practice Address - Phone:601-656-8545
Practice Address - Fax:601-656-3985
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR588458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04634811Medicaid