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NPI Code Detail

MEDICARE: KATHRYN BRADDY-DILLARD APRN-CNP

MEDICARE: KATHRYN BRADDY-DILLARD APRN-CNP
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
1363LF0000XFamily Nurse Practitioner11008012FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376161984
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN BRADDY-DILLARD APRN-CNP
Provider Business Mailing Address
First Line : 894 LAUREL VALLEY DR
Second Line :
City : ORANGE PARK
State : FL
Zip : 32065-2708
Country : US
Telephone Number : 313-407-9173
Fax Number :
Provider Business Practice Location Address
First Line : 4475 SAN JUAN AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-3357
Country : US
Telephone Number : 904-389-0314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2020
Last Update Date : 10/16/2025

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Directions to “ KATHRYN BRADDY-DILLARD APRN-CNP” Practice Location

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