Provider Demographics
NPI:1407850332
Name:BOYD, BRANDY HUSS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:HUSS
Last Name:BOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SOUTHERN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8692
Mailing Address - Country:US
Mailing Address - Phone:304-768-6351
Mailing Address - Fax:
Practice Address - Street 1:215 SOUTHERN WOODS DR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8692
Practice Address - Country:US
Practice Address - Phone:304-768-6351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV293363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV2145AMedicare PIN
P22052Medicare UPIN