Healthcare Provider Details

I. General information

NPI: 1962424234
Provider Name (Legal Business Name): BRENDA T OGLESBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVENUE
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

PO BOX 116638 MEMORIAL HEALTH PARTNERS FOUNDATION
ATLANTA GA
30368
US

V. Phone/Fax

Practice location:
  • Phone: 423-499-5655
  • Fax: 423-499-8085
Mailing address:
  • Phone: 423-499-5655
  • Fax: 423-499-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN0000005595
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: