Provider Demographics
NPI:1598933657
Name:ANSLEY, BRANT STEPHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANT
Middle Name:STEPHEN
Last Name:ANSLEY
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:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4444
Practice Address - Street 1:444 FOUR STATES DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4444
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008003355363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical