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General NPI Number Information
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NPI Number | 1063158723
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Entity Type | Individual
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Provider Name | MICHELE KYLE BRADSHAW
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Gender | Female
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 6120 BALTIMORE NATIONAL PIKE STE 200
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City | CATONSVILLE
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State | MD
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Zip | 21228-2930
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Country | US
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Telephone | 301-291-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 11140 ROCKVILLE PIKE STE 100
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City | ROCKVILLE
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State | MD
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Zip | 20852-3149
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Country | US
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Telephone | 240-604-6074
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Fax | 301-709-6106
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024184288
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License Number State | VA
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