Provider Demographics
NPI:1356448989
Name:STEPHENS, BRENDA ANNE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1658
Practice Address - Country:US
Practice Address - Phone:270-326-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000577781OtherANTHEM BC & BS
KY000000819232OtherBCBS BAPTIST HEALTH MADISONVILLE
000000371551OtherBCBS PROVIDER NUMBER
KY78005196Medicaid
KY000000819232OtherBCBS BAPTIST HEALTH MADISONVILLE
KYK090031Medicare PIN
000000371551OtherBCBS PROVIDER NUMBER
KY0576103Medicare PIN
KY0706402Medicare PIN
KY78005196Medicaid