Healthcare Provider Details

I. General information

NPI: 1639787997
Provider Name (Legal Business Name): MELISSA GAIL BRAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 IRISH MOUNTAIN RD
SHADY SPRING WV
25918-8171
US

IV. Provider business mailing address

PO BOX 1124
BEAVER WV
25813-1124
US

V. Phone/Fax

Practice location:
  • Phone: 304-575-5989
  • Fax:
Mailing address:
  • Phone: 304-575-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: