Healthcare Provider Details

I. General information

NPI: 1316162696
Provider Name (Legal Business Name): BRADLEY JOSEPH HUTCHINS MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 US HIGHWAY 62 W
PRINCETON KY
42445-2435
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
PRINCETON KY
42445-2430
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-9599
  • Fax: 888-814-0944
Mailing address:
  • Phone: 270-365-0300
  • Fax: 270-365-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 305
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: