Basic Information
| Provider Information | |||||||||
| NPI: | 1033558549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWEES | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | N. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 VALLEY DRIVE | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046754340 | ||||||||
| FaxNumber: | 3046756911 | ||||||||
| Practice Location | |||||||||
| Address1: | 2007 2ND STREET | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047735179 | ||||||||
| FaxNumber: | 3047735035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | APRN75688 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | COA.14736-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3810026234 | 05 | WV | MEDICAID | 0088158 | 05 | OH | MEDICAID |