Healthcare Provider Details

I. General information

NPI: 1295690824
Provider Name (Legal Business Name): BRADLEY THOMAS BIGGAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 TENNESSEE AVE
FORT CAMPBELL KY
42223-5940
US

IV. Provider business mailing address

6101 TENNESSEE AVE
FORT CAMPBELL KY
42223-5940
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-5836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number4060-2604-2640
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: