Provider Demographics
NPI:1417216508
Name:MANLEY, BRYANA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIE
Other - Middle Name:
Other - Last Name:BOHM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10100 E SHANNON WOODS CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4106
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:10100 E SHANNON WOODS CIR STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4106
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:316-219-5899
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1106895OtherNCCPA CERTIFICATION
KS15-01551OtherKSBHA PA FEDERAL ACTIVE LICENSE