Provider Demographics
NPI:1497126825
Name:BRUNETTI, CASEY LEIGH SMITH (PA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LEIGH SMITH
Last Name:BRUNETTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1212 GARFIELD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3247
Mailing Address - Country:US
Mailing Address - Phone:304-865-3655
Mailing Address - Fax:304-865-3700
Practice Address - Street 1:1212 GARFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3247
Practice Address - Country:US
Practice Address - Phone:304-865-3655
Practice Address - Fax:304-865-3700
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV1933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant