Provider Demographics
NPI:1679361448
Name:BLACKWELL, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 ELLISON SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CAMP CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25820-9056
Mailing Address - Country:US
Mailing Address - Phone:304-921-6445
Mailing Address - Fax:
Practice Address - Street 1:738 MERCER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3114
Practice Address - Country:US
Practice Address - Phone:304-323-3069
Practice Address - Fax:304-324-7946
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110053163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health