Provider Demographics
NPI:1659671220
Name:WYCHE, BRANDON FRASER (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:FRASER
Last Name:WYCHE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:FCI BUTNER MEDIUM II OLD NC HWY 75
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509
Mailing Address - Country:US
Mailing Address - Phone:919-575-8000
Mailing Address - Fax:
Practice Address - Street 1:FCI BUTNER MEDIUM II OLD NC HWY 75
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509
Practice Address - Country:US
Practice Address - Phone:919-575-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02562363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical