Healthcare Provider Details

I. General information

NPI: 1609422419
Provider Name (Legal Business Name): KASEY BRADSHAW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOUNDATION WAY
MARTINSBURG WV
25401-9003
US

IV. Provider business mailing address

2000 FOUNDATION WAY
MARTINSBURG WV
25401-9003
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-6900
  • Fax:
Mailing address:
  • Phone: 304-596-6900
  • Fax: 304-596-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number103927
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number69841
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: