Provider Demographics
NPI:1891311858
Name:BEAVER, BRANDI K
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:K
Last Name:BEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:K
Other - Last Name:MATHENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2439
Mailing Address - Country:US
Mailing Address - Phone:740-516-3802
Mailing Address - Fax:
Practice Address - Street 1:331 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2439
Practice Address - Country:US
Practice Address - Phone:740-516-3802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4462020175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist