Provider Demographics
NPI:1801364211
Name:MCCROBIE, BRANDON SCOTT (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:MCCROBIE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GRACIE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1665
Mailing Address - Country:US
Mailing Address - Phone:240-899-0989
Mailing Address - Fax:
Practice Address - Street 1:305 GRACIE LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1665
Practice Address - Country:US
Practice Address - Phone:240-899-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN101625-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM-261-098-760-767OtherDRIVERS LICENSE