Healthcare Provider Details

I. General information

NPI: 1588007843
Provider Name (Legal Business Name): BRADLEY ALEXANDER BIGFORD NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 E GENTRY WAY STE 210
MERIDIAN ID
83642-3550
US

IV. Provider business mailing address

PO BOX 44953
BOISE ID
83711-0953
US

V. Phone/Fax

Practice location:
  • Phone: 986-224-8280
  • Fax: 844-268-7286
Mailing address:
  • Phone: 208-895-6729
  • Fax: 208-855-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1252A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: