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General NPI Number Information
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NPI Number | 1336826692
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Entity Type | Individual
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Provider Name | BRADLEY KEVIN YOUNG FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 2041 FISHER ARCH SUITE 140
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456
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Country | US
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Telephone | 757-301-6985
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Fax |
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Provider Business Mailing Address
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Address Line | 8756 S 1700 E
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City | SANDY
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State | UT
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Zip | 84093-1408
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Country | US
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Telephone | 208-380-0763
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11388965-4405
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License Number State | UT
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