Healthcare Provider Details

I. General information

NPI: 1306935721
Provider Name (Legal Business Name): BRANDI HUFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3997 BECKLEY RD
PRINCETON WV
24740-7660
US

IV. Provider business mailing address

3997 BECKLEY RD
PRINCETON WV
24740-7660
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-5499
  • Fax:
Mailing address:
  • Phone: 304-431-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01221
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: