Healthcare Provider Details

I. General information

NPI: 1356439962
Provider Name (Legal Business Name): THERESA BRADLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BISHOP CT
MOREHEAD KY
40351-1009
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-2096
  • Fax: 606-784-5886
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1073566
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: