Provider Demographics
NPI:1912997792
Name:HIGHLEY, BRENDA C (CRNA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:HIGHLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 DORCHESTER SQ S
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-7302
Mailing Address - Country:US
Mailing Address - Phone:614-523-2211
Mailing Address - Fax:614-523-2288
Practice Address - Street 1:275 TAYLOR STATION RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1445
Practice Address - Country:US
Practice Address - Phone:614-523-2211
Practice Address - Fax:614-523-2288
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-149610 NA-00771207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0837750Medicaid
OHHI8220111Medicare PIN