Healthcare Provider Details

I. General information

NPI: 1700267507
Provider Name (Legal Business Name): BRADLEY ELLIOTT CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E 8TH ST
ANNISTON AL
36207-5731
US

IV. Provider business mailing address

1225 WOODMONT RD
ANNISTON AL
36207-1702
US

V. Phone/Fax

Practice location:
  • Phone: 256-236-3403
  • Fax: 256-241-9909
Mailing address:
  • Phone: 256-473-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number841-13229
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-136329
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: