Healthcare Provider Details

I. General information

NPI: 1881781623
Provider Name (Legal Business Name): BRANDI MANNING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6572 MIDLAND TRAIL RD
ASHLAND KY
41102-9286
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-928-7755
  • Fax: 606-928-0052
Mailing address:
  • Phone: 606-408-5044
  • Fax: 606-408-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA546
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: