Healthcare Provider Details

I. General information

NPI: 1750535795
Provider Name (Legal Business Name): JONATHAN CASEY BRANTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD EMERGENCY DEPARTMENT
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2150
  • Fax: 270-444-2985
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44380
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number44380
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: