MEDICARE: BRENDA K DODDS RN, FNP-C, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	092350	MO

General Provider Information

NPI Number	:	1467455568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA K DODDS RN, FNP-C, FNP

Provider Business Mailing Address
First Line	:	2305 SOUTH 65 HIGHWAY, BUILDING A
Second Line	:
City	:	MARSHALL
State	:	MO
Zip	:	65340-3702
Country	:	US
Telephone Number	:	660-886-7800
Fax Number	:	660-886-3328

Provider Business Practice Location Address
First Line	:	2305 SOUTH 65 HIGHWAY, BUILDING A
Second Line	:
City	:	MARSHALL
State	:	MO
Zip	:	65340-3702
Country	:	US
Telephone Number	:	660-886-7800
Fax Number	:	660-831-3328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/26/2024

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