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General NPI Number Information
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NPI Number | 1477210003
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Entity Type | Individual
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Provider Name | KRISTEN CAROLE BRADLEY
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Gender | Female
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Dates
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Enumeration Date | 11/18/2021
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 145 INVERNESS DR E STE 220
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City | ENGLEWOOD
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State | CO
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Zip | 80112-5172
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Country | US
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Telephone | 303-699-7325
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Fax |
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Provider Business Mailing Address
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Address Line | 101 9TH ST E
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City | ST PETERSBURG
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State | FL
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Zip | 33715-2204
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Country | US
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Telephone | 203-814-7528
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0007178
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License Number State | CO
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Taxonomy #2
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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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