MEDICARE: BRENDA KAY RICHARDS APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	109700	OK
2	163WG0000X	General Practice Registered Nurse	109700	OK

General Provider Information

NPI Number	:	1316590714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA KAY RICHARDS APRN

Provider Business Mailing Address
First Line	:	PO BOX 825
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74013-0825
Country	:	US
Telephone Number	:	918-261-4053
Fax Number	:

Provider Business Practice Location Address
First Line	:	4870 S LEWIS AVE STE 240
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-5153
Country	:	US
Telephone Number	:	918-982-6524
Fax Number	:	539-399-7559

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

Provider Enumeration Date	:	07/24/2019
Last Update Date	:	07/29/2025

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