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General NPI Number Information
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NPI Number | 1578964417
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Entity Type | Individual
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Provider Name | KRISTEN NICOLE BRADLEY RN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 820 W 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-3621
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Country | US
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Telephone | 405-858-1754
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 WATERMARK BLVD APT 522
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-5216
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Country | US
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Telephone | 405-420-5288
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 100583
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License Number State | OK
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