Provider Demographics
NPI:1194024554
Name:HIXON VERMILLION, BRENDA KAY (MS, RN, ACNS-BC)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAY
Last Name:HIXON VERMILLION
Suffix:
Gender:F
Credentials:MS, RN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-1809
Mailing Address - Country:US
Mailing Address - Phone:937-653-8460
Mailing Address - Fax:614-293-6330
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:1099 RHODES HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-5542
Practice Address - Fax:614-293-6330
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN197465163WC0200X
OHCOA09192NP363LA2200X
OHCOA07693NS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health