Provider Demographics
NPI:1881781623
Name:MANNING, BRANDI (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:MANNING
Suffix:
Gender:F
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 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-5044
Mailing Address - Fax:606-408-7425
Practice Address - Street 1:6572 MIDLAND TRAIL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9286
Practice Address - Country:US
Practice Address - Phone:606-928-7755
Practice Address - Fax:606-928-0052
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95006029Medicaid
OH0068722Medicaid
KY3400340Medicare PIN
KY0586628Medicare PIN
OH0068722Medicaid
KY0351455Medicare PIN
KY95006029Medicaid
KYP00286374Medicare PIN
KY0307657Medicare PIN