Healthcare Provider Details

I. General information

NPI: 1447638325
Provider Name (Legal Business Name): BRENDA K FISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BROWNS WAY RD
MIDLOTHIAN VA
23114-9501
US

IV. Provider business mailing address

11986 DOLT RD
DELPHOS OH
45833-8952
US

V. Phone/Fax

Practice location:
  • Phone: 804-419-9101
  • Fax:
Mailing address:
  • Phone: 419-235-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.17222
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190494
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190494
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: