Healthcare Provider Details

I. General information

NPI: 1871330399
Provider Name (Legal Business Name): BROOKLYN PAIGE GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHAMBERS CIRCLE RD
WALKER WV
26180-3585
US

IV. Provider business mailing address

47 CHAMBERS CIRCLE RD
WALKER WV
26180-3585
US

V. Phone/Fax

Practice location:
  • Phone: 304-679-3309
  • Fax: 304-679-3309
Mailing address:
  • Phone: 304-679-3309
  • Fax: 304-679-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: