Provider Demographics
NPI:1457452351
Name:DAVIS, BRENDA KAY (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:HEISLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12993 OVID RD
Mailing Address - Street 2:
Mailing Address - City:ROCKBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43149-9623
Mailing Address - Country:US
Mailing Address - Phone:740-385-7945
Mailing Address - Fax:740-385-7945
Practice Address - Street 1:12993 OVID RD
Practice Address - Street 2:
Practice Address - City:ROCKBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43149-9623
Practice Address - Country:US
Practice Address - Phone:740-385-7945
Practice Address - Fax:740-385-7945
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-216394163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2072797Medicaid