Healthcare Provider Details

I. General information

NPI: 1295669331
Provider Name (Legal Business Name): BRADY ABBOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 CEDAR HOLLOW LANE
TAYLOR AZ
85939
US

IV. Provider business mailing address

PO BOX 278
TAYLOR AZ
85939-0278
US

V. Phone/Fax

Practice location:
  • Phone: 602-399-4932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number249857
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: