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NPI Code Detail

MEDICARE: MR. BRADLY KENNETH LEROY BROWN PA-C

MEDICARE: MR. BRADLY KENNETH LEROY BROWN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology PhysicianPA60639841WA
2207Q00000XFamily Medicine PhysicianPA965ID

General Provider Information

NPI Number : 1043598477
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADLY KENNETH LEROY BROWN PA-C
Provider Business Mailing Address
First Line : 4003 CREEKSIDE LOOP
Second Line :
City : YAKIMA
State : WA
Zip : 98908-3962
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4003 CREEKSIDE LOOP
Second Line :
City : YAKIMA
State : WA
Zip : 98908-3962
Country : US
Telephone Number : 509-746-4125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2011
Last Update Date : 01/13/2026

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