Provider Demographics
NPI:1265845994
Name:WEST, BRANDON KYLE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:KYLE
Last Name:WEST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2700 WESTSIDE DR NW STE 301
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3699
Mailing Address - Country:US
Mailing Address - Phone:423-479-3900
Mailing Address - Fax:423-303-1234
Practice Address - Street 1:2700 WESTSIDE DR NW STE 301
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-479-3900
Practice Address - Fax:423-303-1234
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2534363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant