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General NPI Number Information
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NPI Number | 1174854293
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Entity Type | Individual
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Provider Name | JEREMY DANIEL BRADY APRN
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Gender | Male
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 07/13/2025
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Provider Practice Location Address
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Address Line | 929 N SAINT FRANCIS AVE
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City | WICHITA
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State | KS
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Zip | 67214-3821
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Country | US
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Telephone | 316-268-5526
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 S COVINGTON ST
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City | WICHITA
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State | KS
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Zip | 67209-4234
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Country | US
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Telephone | 316-300-9838
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01-05306
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | TMP163070
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License Number State | KS
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