Provider Demographics
NPI:1376523878
Name:BRANDT, JEREMY J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:J
Last Name:BRANDT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KS
Mailing Address - Zip Code:66427
Mailing Address - Country:US
Mailing Address - Phone:785-292-4451
Mailing Address - Fax:
Practice Address - Street 1:112 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KS
Practice Address - Zip Code:66427-1403
Practice Address - Country:US
Practice Address - Phone:785-292-4451
Practice Address - Fax:785-292-4286
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500619207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340780AMedicaid
KS30004339400001Medicaid
KS042255Medicare PIN