Healthcare Provider Details

I. General information

NPI: 1356833149
Provider Name (Legal Business Name): CASSIE L. BRADFORD APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 23RD ST STE G10
ASHLAND KY
41101-2886
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-5864
  • Fax: 606-408-6499
Mailing address:
  • Phone: 614-293-8415
  • Fax: 614-293-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022842
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4048490
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.022842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: