Provider Demographics
NPI:1952605107
Name:DEXTER, BRENDA R (FNP C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:DEXTER
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 SHERRILL ST STE B
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5891
Mailing Address - Country:US
Mailing Address - Phone:731-885-8884
Mailing Address - Fax:731-599-9713
Practice Address - Street 1:702 SHERRILL ST STE B
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5891
Practice Address - Country:US
Practice Address - Phone:731-885-8884
Practice Address - Fax:731-599-9713
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily