Provider Demographics
NPI:1316926991
Name:PURSLEY, BRENDA LOUISE (RPA-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:PURSLEY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 7TH ST
Mailing Address - Street 2:PO BOX 564
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-4954
Mailing Address - Country:US
Mailing Address - Phone:620-251-1100
Mailing Address - Fax:620-251-7466
Practice Address - Street 1:209 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4954
Practice Address - Country:US
Practice Address - Phone:620-251-1100
Practice Address - Fax:620-251-7466
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00687363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS970010390OtherTRAVELERS MEDICARE
OK100199200AOtherOKLAHOMA MEDICAID
KS100345380AMedicaid
KS042391OtherBLUE CROSS BLUE SHIELD
KS042391OtherBLUE CROSS BLUE SHIELD
OK100199200AOtherOKLAHOMA MEDICAID
KS100345380AMedicaid