Healthcare Provider Details

I. General information

NPI: 1225098460
Provider Name (Legal Business Name): BRENDA KAY HUENERGARDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 MAIN ST
WOODWARD OK
73801-3046
US

IV. Provider business mailing address

1650 MAIN ST
WOODWARD OK
73801-3046
US

V. Phone/Fax

Practice location:
  • Phone: 580-571-8009
  • Fax: 580-571-8032
Mailing address:
  • Phone: 580-571-8009
  • Fax: 580-571-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOK22843
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: