MEDICARE: REBECCA LYNN BRADEN

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	363LF0000X	Family Nurse Practitioner	3013340	KY
2	363LF0000X	Family Nurse Practitioner	71009808A	IN

General Provider Information

NPI Number	:	1053973875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN BRADEN

Provider Business Mailing Address
First Line	:	151 N GARDENMILE RD
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 N GARDENMILE RD
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5543
Country	:	US
Telephone Number	:	270-830-9186
Fax Number	:

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

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	12/05/2022

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Directions to “ REBECCA LYNN BRADEN ” Practice Location

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