Healthcare Provider Details

I. General information

NPI: 1366365512
Provider Name (Legal Business Name): BLAIR NICOLE BRANTLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

IV. Provider business mailing address

1069 E KARLA AVE
HAYSVILLE KS
67060-1860
US

V. Phone/Fax

Practice location:
  • Phone: 620-524-0799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: