Healthcare Provider Details

I. General information

NPI: 1033558549
Provider Name (Legal Business Name): BRANDON N. DEWEES CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 2ND STREET
MASON WV
25260
US

IV. Provider business mailing address

2520 VALLEY DRIVE
POINT PLEASANT WV
25550
US

V. Phone/Fax

Practice location:
  • Phone: 304-773-5179
  • Fax: 304-773-5035
Mailing address:
  • Phone: 304-675-4340
  • Fax: 304-675-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14736-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN75688
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: