Provider Demographics
NPI:1407619836
Name:HUSTEAD, BRAIDEN ROBERT
Entity Type:Individual
Prefix:
First Name:BRAIDEN
Middle Name:ROBERT
Last Name:HUSTEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E 200 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2969
Mailing Address - Country:US
Mailing Address - Phone:435-301-7310
Mailing Address - Fax:
Practice Address - Street 1:251 E 200 N
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2969
Practice Address - Country:US
Practice Address - Phone:435-301-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator