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General NPI Number Information
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NPI Number | 1013785955
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Entity Type | Individual
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Provider Name | ABIGAIL BRADLEY
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Gender | Female
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 380 CHASE AVE
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City | WALLA WALLA
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State | WA
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Zip | 99362-2924
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Country | US
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Telephone | 509-897-5950
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Fax | 509-879-5570
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Provider Business Mailing Address
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Address Line | 9505 BOB GRAY RD
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City | KNOXVILLE
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State | TN
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Zip | 37923-2112
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Country | US
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Telephone | 386-456-7876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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