Provider Demographics
NPI:1255576195
Name:METHENY, BRANDIE LYNNE (NP)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:LYNNE
Last Name:METHENY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3885
Mailing Address - Country:US
Mailing Address - Phone:304-636-5006
Mailing Address - Fax:304-636-4898
Practice Address - Street 1:501 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3885
Practice Address - Country:US
Practice Address - Phone:304-636-5006
Practice Address - Fax:304-636-4898
Is Sole Proprietor?:No
Enumeration Date:2008-12-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV6414Medicare UPIN