Brian Travis Pendarvis in Noble - Family
Brian Travis Pendarvis - NPI 1417952904
Brian Travis Pendarvis is a Family in Noble, Oklahoma. Brian Travis Pendarvis practices all healthcare services and medical treatments related to Family. The NPI Number for Brian Travis Pendarvis is 1417952904. The last update date is 2014-01-30.
Brian Travis Pendarvis's current location address is 205 South Main Street, Noble, Oklahoma. You can contact this provider via phone number 4058725403 and fax number 4058725407. The mailing address for Brian Travis Pendarvis is 205 South Main Street, Noble, Oklahoma. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Brian Travis Pendarvis |
|---|---|
| Address | 205 South Main Street, Noble, Oklahoma |
| Phone Number | 4058725403 |
| Fax Number | 4058725407 |
| Sole Proprietor | Y |
| Credentials | ARNP |
NPI Number Detail
| NPI Number | 1417952904 |
|---|---|
| Provider Enumeration Date | 2005-06-20 |
| Last Updated Date | 2014-01-30 |
Provider Mailing Address Detail
| Address | 205 South Main Street |
|---|---|
| City | Noble |
| State | Oklahoma (OK) |
| Post Code | 730680 |
| Phone Number | 4058725403 |
| Fax Number | 4058725407 |
Provider's Primary Taxonomy Detail
| Speciality | Family |
|---|---|
| Taxonomy | 363Lf0000X |
| Licence No | R0067224 |
|
Definition: An advanced practice registered nurse expert in primary healthcare for patients of all ages. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 200043980A | OK | -- |
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What is the Brian Travis Pendarvis's unique identification number?
The Brian Travis Pendarvis has been assigned the NPI (National Provider Identifier) Number 1417952904 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you provide the complete physical address where Brian Travis Pendarvis is located?
The Brian Travis Pendarvis is situated at the following address: 205 South Main Street, Noble, OK, 730680.
What is the Brian Travis Pendarvis's area of specialization and corresponding taxonomy classification?
The Brian Travis Pendarvis's specialty field is Family, and it falls under the taxonomy code 363Lf0000X, which categorizes healthcare providers based on their specialties.
On what date was the 1417952904 assigned to Brian Travis Pendarvis?
The Brian Travis Pendarvis was issued its 1417952904 on 2005-06-20, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
As of what date were the details related to Brian Travis Pendarvis most recently updated or revised?
The information pertaining to Brian Travis Pendarvis, including its address, specialty, and other relevant details, was last updated or revised on 2014-01-30.