Provider Demographics
NPI:1760379713
Name:WOODRUM, BRANDON RAY
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:RAY
Last Name:WOODRUM
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 1:150 MORRIS CT
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1453
Mailing Address - Country:US
Mailing Address - Phone:304-760-9755
Mailing Address - Fax:
Practice Address - Street 1:150 MORRIS CT
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1453
Practice Address - Country:US
Practice Address - Phone:304-760-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV123582363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner