Provider Demographics
NPI:1104064823
Name:FRALEY, BRANDON K (PA)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:K
Last Name:FRALEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1100 HIGHLAND DR
Mailing Address - Street 2:FL 3
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-3923
Mailing Address - Country:US
Mailing Address - Phone:785-243-4272
Mailing Address - Fax:785-243-4275
Practice Address - Street 1:1100 HIGHLAND DR
Practice Address - Street 2:FL 3
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-3923
Practice Address - Country:US
Practice Address - Phone:785-243-4275
Practice Address - Fax:785-243-4275
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01635363A00000X
NE1425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201088600AMedicaid