Healthcare Provider Details

I. General information

NPI: 1346413358
Provider Name (Legal Business Name): BRANDON KEITH TILLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 COMMERCE ST BLDG A
SAINT FRANCISVILLE LA
70775-4409
US

IV. Provider business mailing address

PO BOX 387
SAINT FRANCISVILLE LA
70775-0387
US

V. Phone/Fax

Practice location:
  • Phone: 225-635-3269
  • Fax: 855-392-3007
Mailing address:
  • Phone: 225-635-3269
  • Fax: 855-392-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number205178
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: