Provider Demographics
NPI:1316422876
Name:LUCAS, BRENDAN KYLE (PA-C)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:KYLE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:148 ALBRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8744
Mailing Address - Country:US
Mailing Address - Phone:270-617-8195
Mailing Address - Fax:
Practice Address - Street 1:810 ROYAL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3759
Practice Address - Country:US
Practice Address - Phone:615-619-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56942363A00000X
TN4203363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant