Provider Demographics
NPI:1366415333
Name:JONES, BRENDA J (MSN, RN, APRN, BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:JONES
Suffix:
Gender:F
Credentials:MSN, RN, APRN, BC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:HICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, RN, APRN, BC
Mailing Address - Street 1:1507 SW TWINCREEK PL
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-8893
Mailing Address - Country:US
Mailing Address - Phone:816-299-8482
Mailing Address - Fax:
Practice Address - Street 1:1507 SW TWINCREEK PL
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8893
Practice Address - Country:US
Practice Address - Phone:816-299-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO069887363LF0000X
KS45182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP37155Medicare UPIN