NPI Code Detail JSON Logo

1982958948 NPI number — BETHANY B BRADLEY CRNA

NPI Number: 1982958948
Health Care Provider/Practitioner: BETHANY B BRADLEY CRNA

Information about “1982958948” NPI (BETHANY B BRADLEY CRNA) exists in 1982958948 in HTML format HTML  |  1982958948 in plain Text format TXT  |  1982958948 in PDF (Portable Document Format) PDF  |  1982958948 in an XML format XML  formats.

NPI Number : 1982958948 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982958948",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRADLEY",
    "FirstName": "BETHANY",
    "MiddleName": "B",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SKELTON",
    "OtherFirstName": "BETHANY",
    "OtherMiddleName": "B",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CRNA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "9263 MEDICAL PLAZA DR",
    "SecondLineMailingAddress": "STE E",
    "MailingAddressCityName": "CHARLESTON",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29406-7112",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-572-1228",
    "MailingAddressFaxNumber": "843-576-6168",
    "FirstLinePracticeLocationAddress": "171 ASHLEY AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29425-7112",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-792-1414",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/30/2012",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": "100208",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "18110",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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