Provider Demographics
NPI:1053423095
Name:RENDER, BRENDA KAYE (CRNA)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAYE
Last Name:RENDER
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 1:675 COX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-3150
Mailing Address - Country:US
Mailing Address - Phone:423-349-4314
Mailing Address - Fax:423-349-0799
Practice Address - Street 1:1850 OLD KNOXVILLE HWY
Practice Address - Street 2:CLAIBORNE COUNTY HOSPITAL
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879
Practice Address - Country:US
Practice Address - Phone:423-626-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000051615367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3629642Medicaid
TN3629642Medicaid