Healthcare Provider Details

I. General information

NPI: 1124064068
Provider Name (Legal Business Name): BARBARA ANN BRADLEY CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA MISITA

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 COMMERCIAL ST
ASTORIA OR
97103-3327
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 503-325-8315
  • Fax:
Mailing address:
  • Phone: 590-865-2395
  • Fax: 509-865-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10052426
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR762681
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: