Healthcare Provider Details

I. General information

NPI: 1134853278
Provider Name (Legal Business Name): BRANDI CARPENTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 SKIDMORE LN
SUTTON WV
26601-9272
US

IV. Provider business mailing address

273 SKIDMORE LN
SUTTON WV
26601-9272
US

V. Phone/Fax

Practice location:
  • Phone: 304-765-4400
  • Fax: 304-765-0354
Mailing address:
  • Phone: 304-765-4400
  • Fax: 304-765-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113814
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number98162
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: