Provider Demographics
NPI:1023345584
Name:EMBRY, BRANDON H (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:H
Last Name:EMBRY
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 1:404 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1301
Mailing Address - Country:US
Mailing Address - Phone:859-737-5333
Mailing Address - Fax:859-737-0070
Practice Address - Street 1:235 BOGGS LN STE 7
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3325
Practice Address - Country:US
Practice Address - Phone:859-625-9959
Practice Address - Fax:859-625-9958
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA614363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100108580Medicaid
KY7100108580Medicaid
KY11478780OtherCAQH
KY11478780OtherCAQH
KY0750007Medicare PIN