Provider Demographics
NPI:1952300808
Name:BROWNING-BREHM, METESSA L (DIETITITAN)
Entity Type:Individual
Prefix:MRS
First Name:METESSA
Middle Name:L
Last Name:BROWNING-BREHM
Suffix:
Gender:F
Credentials:DIETITITAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 BALL PARK RD
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-1701
Mailing Address - Country:US
Mailing Address - Phone:606-574-8425
Mailing Address - Fax:606-574-8013
Practice Address - Street 1:306 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3142
Practice Address - Country:US
Practice Address - Phone:304-255-3000
Practice Address - Fax:606-574-8013
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVBRMT73132Medicare ID - Type Unspecified