Healthcare Provider Details

I. General information

NPI: 1841436417
Provider Name (Legal Business Name): BRADLEY GAIL JELLERICHS A.R.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 LOGAN AVE N
RENTON WA
98057-5535
US

IV. Provider business mailing address

PO BOX 3707 MC 99-1MD
SEATTLE WA
98124
US

V. Phone/Fax

Practice location:
  • Phone: 312-544-2000
  • Fax:
Mailing address:
  • Phone: 312-544-2000
  • Fax: 425-965-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60128753
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 60023039
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberAP60128753
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: