MEDICARE: MRS. ASHLEY NICOLE BRADFISCH NP-C

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	163W00000X	Registered Nurse	2015013644	MO
2	163W00000X	Registered Nurse	2148805	MN
3	363LA2100X	Acute Care Nurse Practitioner	2019002363	MO

General Provider Information

NPI Number	:	1427512482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY NICOLE BRADFISCH NP-C

Provider Business Mailing Address
First Line	:	1209 PEBBLECREEK DR APT A
Second Line	:
City	:	WARRENSBURG
State	:	MO
Zip	:	64093-9514
Country	:	US
Telephone Number	:	612-839-8018
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 E MEYER BLVD STE 209
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1149
Country	:	US
Telephone Number	:	816-235-3932
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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