MEDICARE: KIM E BRAGDON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1345168092	KS
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	5344304092	KS

General Provider Information

NPI Number	:	1043551237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM E BRAGDON APRN

Provider Business Mailing Address
First Line	:	11875 S SUNSET DR
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-2793
Country	:	US
Telephone Number	:	913-477-8351
Fax Number	:	913-826-1300

Provider Business Practice Location Address
First Line	:	11875 S SUNSET DR
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-2793
Country	:	US
Telephone Number	:	913-477-8351
Fax Number	:	913-826-1300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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