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NPI Code Detail

MEDICARE: TIFFANI L BRADBURY FNP

MEDICARE: TIFFANI L BRADBURY FNP
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
1363LF0000XFamily Nurse Practitioner53-82316-092KS
2363LF0000XFamily Nurse Practitioner2018022116MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12018022116OTHERMOCERTIFIED NURSE PRACTITIONER
2F06181383OTHERMOAMERICAN ACADEMY OF NURSE PRACTITIONERS

General Provider Information

NPI Number : 1538655535
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANI L BRADBURY FNP
Provider Business Mailing Address
First Line : 300 UTAH ST
Second Line :
City : HIAWATHA
State : KS
Zip : 66434-2326
Country : US
Telephone Number : 785-742-2131
Fax Number : 785-742-6558
Provider Business Practice Location Address
First Line : 300 UTAH ST
Second Line :
City : HIAWATHA
State : KS
Zip : 66434-2326
Country : US
Telephone Number : 785-742-2131
Fax Number : 785-742-6558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2018
Last Update Date : 12/31/2025

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