Healthcare Provider Details

I. General information

NPI: 1740361815
Provider Name (Legal Business Name): BRADLEY G GAMMILL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PATTIE A CLAY HOSPITAL 801 EASTERN BYPASS
RICHMOND KY
40475
US

IV. Provider business mailing address

795 EASTERN BYP BUILDING 2, SUITE 6
RICHMOND KY
40475-2406
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-1879
  • Fax: 859-625-3171
Mailing address:
  • Phone: 859-624-1879
  • Fax: 859-625-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1090024
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: