Provider Demographics
NPI:1508530056
Name:FLEMING, BRANDI JO
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:JO
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2041
Mailing Address - Country:US
Mailing Address - Phone:304-559-5905
Mailing Address - Fax:
Practice Address - Street 1:403 S FRONT ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2041
Practice Address - Country:US
Practice Address - Phone:304-559-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1255523494Medicaid
WV1356607394Medicaid
WV1821206228Medicaid