Healthcare Provider Details

I. General information

NPI: 1043833791
Provider Name (Legal Business Name): RYAN DAVID BRANTLEY P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CHARLES PL
MANHATTAN KS
66502-2750
US

IV. Provider business mailing address

1600 CHARLES PL
MANHATTAN KS
66502-2750
US

V. Phone/Fax

Practice location:
  • Phone: 785-537-4200
  • Fax: 844-749-1114
Mailing address:
  • Phone: 785-537-4200
  • Fax: 844-749-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02376
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: