=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518707066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENNAN GAGE RHOADES NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2024
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1249 15TH STREET SUITE 3000
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-3663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-691-1000
-----------------------------------------------------
Fax | 304-691-1693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1448 10TH AVENUE SUITE 304
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25701-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-691-6381
-----------------------------------------------------
Fax | 304-691-8591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0036217
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 105393
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------