Healthcare Provider Details

I. General information

NPI: 1174854293
Provider Name (Legal Business Name): JEREMY DANIEL BRADY APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS AVE
WICHITA KS
67214-3821
US

IV. Provider business mailing address

2302 S COVINGTON ST
WICHITA KS
67209-4234
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5526
  • Fax:
Mailing address:
  • Phone: 316-300-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberTMP163070
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number01-05306
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: