=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245032614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH CATHERINE BRADBERRY NNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 TAYLOR RD
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-3511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-747-8442
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2241 TEMPLE RD
-----------------------------------------------------
City | CLANTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35046-6020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-217-6914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LN0005X
-----------------------------------------------------
Taxonomy Name | Critical Care Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | 1-185158
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------