Provider Demographics
NPI:1912556655
Name:HAYHURST, BRANDI ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ELIZABETH
Last Name:HAYHURST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-0310
Mailing Address - Country:US
Mailing Address - Phone:304-872-7063
Mailing Address - Fax:304-872-7080
Practice Address - Street 1:400 FAIRVIEW HEIGHTS RD STE 302
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9308
Practice Address - Country:US
Practice Address - Phone:304-872-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV104152OtherAPRN LICENSE
WV68226OtherRN LICENSE