Provider Demographics
NPI:1427895317
Name:BROYLES, KANDI HALL
Entity type:Individual
Prefix:
First Name:KANDI
Middle Name:HALL
Last Name:BROYLES
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 1:11358 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:WV
Mailing Address - Zip Code:24924-9102
Mailing Address - Country:US
Mailing Address - Phone:304-653-4320
Mailing Address - Fax:304-653-4320
Practice Address - Street 1:11358 SENECA TRL
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924-9102
Practice Address - Country:US
Practice Address - Phone:304-653-4320
Practice Address - Fax:304-653-4320
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist