Healthcare Provider Details

I. General information

NPI: 1568975183
Provider Name (Legal Business Name): KRISTIN BRADSHAW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN SCHUTTE

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 COLLEGE AVE
QUINCY IL
62301-2600
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 217-214-5800
  • Fax: 217-214-5805
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017038785
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016913
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: