Provider Demographics
NPI:1164193405
Name:BRANHAM-BROWN, CARA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:BRANHAM-BROWN
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WESTLAND EST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9704
Mailing Address - Country:US
Mailing Address - Phone:304-550-3098
Mailing Address - Fax:
Practice Address - Street 1:132 WESTLAND EST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9704
Practice Address - Country:US
Practice Address - Phone:304-550-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered