Provider Demographics
NPI:1720963010
Name:HEADLEY, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:HEADLEY
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 1:212 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:WV
Mailing Address - Zip Code:26034-1452
Mailing Address - Country:US
Mailing Address - Phone:330-843-2429
Mailing Address - Fax:
Practice Address - Street 1:212 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1452
Practice Address - Country:US
Practice Address - Phone:330-843-2429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist