Provider Demographics
NPI:1245927615
Name:MOOREHEAD, BREANNA MARIE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:MOOREHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26750-1105
Mailing Address - Country:US
Mailing Address - Phone:304-788-5467
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:114 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:WV
Practice Address - Zip Code:26750-1105
Practice Address - Country:US
Practice Address - Phone:304-788-5467
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant