Healthcare Provider Details

I. General information

NPI: 1760303606
Provider Name (Legal Business Name): BRANDON HEDRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKEMARY DR
PAOLA KS
66071-1855
US

IV. Provider business mailing address

100 LAKEMARY DR
PAOLA KS
66071-1855
US

V. Phone/Fax

Practice location:
  • Phone: 913-359-0934
  • Fax: 913-359-0934
Mailing address:
  • Phone: 913-359-0934
  • Fax: 913-359-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberK03-37-6188
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: