Provider Demographics
NPI:1780006049
Name:ADDAIR, BRITTANY GRACE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:GRACE
Last Name:ADDAIR
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 1:454 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2029
Mailing Address - Country:US
Mailing Address - Phone:304-436-8461
Mailing Address - Fax:
Practice Address - Street 1:454 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2029
Practice Address - Country:US
Practice Address - Phone:304-436-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant