Provider Demographics
NPI:1962424234
Name:OGLESBY, BRENDA T (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:T
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116638
Mailing Address - Street 2:MEMORIAL HEALTH PARTNERS FOUNDATION
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368
Mailing Address - Country:US
Mailing Address - Phone:423-499-5655
Mailing Address - Fax:423-499-8085
Practice Address - Street 1:2525 DESALES AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-499-5655
Practice Address - Fax:423-499-8085
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005595363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3345995Medicaid
TN4114023OtherBCBS-TN
TNP00225213OtherRAILROAD MEDICARE
TN3345995Medicare ID - Type UnspecifiedMEDICARE
TN4114023OtherBCBS-TN