Provider Demographics
NPI:1629118070
Name:BATTS, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 RASBERRY DR N
Mailing Address - Street 2:806 TARBORO ST SUITE B1
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8601
Mailing Address - Country:US
Mailing Address - Phone:252-243-5943
Mailing Address - Fax:
Practice Address - Street 1:806 TARBORO ST W
Practice Address - Street 2:SUITE B1
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4771
Practice Address - Country:US
Practice Address - Phone:252-243-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3338251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418154Medicaid
NC7804981Medicaid
NC6601451Medicaid