MEDICARE: BRENDA KAY PAINTER 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	363LW0102X	Women's Health Nurse Practitioner	71001773A	IN
2	363LF0000X	Family Nurse Practitioner	71001773A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114013083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA KAY PAINTER FNP

Provider Business Mailing Address
First Line	:	8695 W JACK CARNES WAY
Second Line	:
City	:	FRENCH LICK
State	:	IN
Zip	:	47432-1302
Country	:	US
Telephone Number	:	812-936-3900
Fax Number	:	812-936-3904

Provider Business Practice Location Address
First Line	:	8163 W STATE ROAD 56 STE A
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-7706
Country	:	US
Telephone Number	:	812-723-7125
Fax Number	:	812-936-2599

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/24/2024

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