Provider Demographics
NPI:1720798705
Name:HAYNES-GUNNOE, BRANDI DAWN (PRSS)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:DAWN
Last Name:HAYNES-GUNNOE
Suffix:
Gender:F
Credentials:PRSS
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 162
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:WV
Mailing Address - Zip Code:25206-0162
Mailing Address - Country:US
Mailing Address - Phone:304-881-6712
Mailing Address - Fax:
Practice Address - Street 1:200 UPPER KANAWHA VALLEY
Practice Address - Street 2:
Practice Address - City:CABIN CREEK
Practice Address - State:WV
Practice Address - Zip Code:25035
Practice Address - Country:US
Practice Address - Phone:304-553-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist