Healthcare Provider Details

I. General information

NPI: 1316926991
Provider Name (Legal Business Name): BRENDA LOUISE PURSLEY RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W 7TH ST
COFFEYVILLE KS
67337-4954
US

IV. Provider business mailing address

209 W 7TH ST PO BOX 564
COFFEYVILLE KS
67337-4954
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-1100
  • Fax: 620-251-7466
Mailing address:
  • Phone: 620-251-1100
  • Fax: 620-251-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15-00687
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: