Provider Demographics
NPI:1396330437
Name:FLEAMING, BRANDY
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:FLEAMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:SMITHERS
Mailing Address - State:WV
Mailing Address - Zip Code:25186-0052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25186
Practice Address - Country:US
Practice Address - Phone:304-719-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker