Provider Demographics
NPI:1578757183
Name:HENDRIX, BRANDON T (PA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:T
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 N 14TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2368
Mailing Address - Country:US
Mailing Address - Phone:620-225-7744
Mailing Address - Fax:620-225-7002
Practice Address - Street 1:2300 N 14TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2368
Practice Address - Country:US
Practice Address - Phone:620-225-7744
Practice Address - Fax:620-225-7002
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KST01508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical