MEDICARE: MS. BRENDA KAY CLARKE FNP-C

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	240095	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74-1715140	OTHER	TX	BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC.
2	1497183883	OTHER		ST. JOSEPH HEALTH POINT BRYAN - FACILITY NPI

General Provider Information

NPI Number	:	1164858767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA KAY CLARKE FNP-C

Provider Business Mailing Address
First Line	:	1500 UNIVERSITY DR E
Second Line	:	SUITE 100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-2600
Country	:	US
Telephone Number	:	979-846-1100
Fax Number	:	979-260-9390

Provider Business Practice Location Address
First Line	:	3370 S TEXAS AVE
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-3127
Country	:	US
Telephone Number	:	979-595-1700
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	06/18/2026

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