Individual provider Active NPI

Brenda Harding, FNP-C

  • Family Nurse Practitioner
  • Queen Creek, AZ
National Provider Identifier
1194074179
Registry record updated Apr 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP4673 Issued in AZ
Practice address
22717 S Ellsworth Rd
Suite B101
Queen Creek, AZ 85142-6127
Phone
(480) 306-5650
Fax
(480) 986-4300
NPI assigned
Sep 5, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TAP4673 AZ
Family Nurse Practitioner 363LF0000X AP4673 AZ Primary
Family Health Clinical Nurse Specialist 364SF0001X RN159911 AZ

Addresses

Primary practice location

22717 S Ellsworth Rd
Suite B101
Queen Creek, AZ 85142-6127

Mailing address

85 W Combs Rd
Suite 101-196
San Tan Valley, AZ 85140-9105
Phone (480) 306-5650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121214000301 AZ Practitioner - Nurse Practitioner 7416109665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

22717 S Ellsword Rd
Suite B101
Queen Creek, AZ 85142-7572
Phone (480) 306-5650

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP4673AZMDFamily Nurse Practitioner
TAP4673AZMDFamily Nurse Practitioner
RN159911AZMDFamily Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Health LLC CurrentSince Dec 21, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1194074179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 W COMBS RD",
            "address_2": "SUITE 101-196",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851409105",
            "telephone_number": "480-306-5650",
            "fax_number": "480-986-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22717 S ELLSWORTH RD",
            "address_2": "SUITE B101",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851426127",
            "telephone_number": "480-306-5650",
            "fax_number": "480-986-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDING",
        "first_name": "BRENDA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "TAP4673",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP4673",
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "AZ",
            "license": "RN159911",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Queen Creek, AZ

Sources for this page

Verify at the official NPI Registry.