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General NPI Number Information
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NPI Number | 1649101874
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Entity Type | Individual
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Provider Name | BRADLEY W VINCENT
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Gender | Male
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Dates
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Enumeration Date | 05/27/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 29 BLACK COAL DRIVE
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City | FORT WASHAKIE
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State | WY
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Zip | 82514
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Country | US
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Telephone | 307-332-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 29 BLACK COAL DRIVE
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City | FORT WASHAKIE
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State | WY
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Zip | 82514
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Country | US
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Telephone | 307-332-7300
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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 | 59848
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 31211
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License Number State | WY
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