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NPI Code Detail

MEDICARE: BRANDY NICOLE SMITH MA

MEDICARE: BRANDY NICOLE SMITH MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerWV

General Provider Information

NPI Number : 1053247056
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY NICOLE SMITH MA
Provider Business Mailing Address
First Line : 112 RYAN VLG
Second Line :
City : PRINCETON
State : WV
Zip : 24739-9256
Country : US
Telephone Number : 304-818-2222
Fax Number : 681-282-5600
Provider Business Practice Location Address
First Line : 1345 MERCER ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3033
Country : US
Telephone Number : 304-818-2222
Fax Number : 681-282-5600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ BRANDY NICOLE SMITH MA” Practice Location

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