Provider Demographics
NPI:1134625148
Name:NANCE, BRANDON KEITH (DO)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:KEITH
Last Name:NANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 HUB BLVD APT 2924
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-8947
Mailing Address - Country:US
Mailing Address - Phone:606-521-5393
Mailing Address - Fax:
Practice Address - Street 1:421 US 31W BYP
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1775
Practice Address - Country:US
Practice Address - Phone:270-782-0151
Practice Address - Fax:270-793-5688
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05260207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine