Provider Demographics
NPI:1023397304
Name:HARRISON, BRENDA JO (LPN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JO
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 FIRE TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BALD KNOB
Mailing Address - State:AR
Mailing Address - Zip Code:72010-9739
Mailing Address - Country:US
Mailing Address - Phone:501-283-0235
Mailing Address - Fax:
Practice Address - Street 1:3302 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4886
Practice Address - Country:US
Practice Address - Phone:501-268-4181
Practice Address - Fax:501-268-5301
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL44411164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse