MEDICARE: RACHEL RYLAND BRADLEY PA-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	363A00000X	Physician Assistant		NC
2	363A00000X	Physician Assistant	PA.0007721	CO

General Provider Information

NPI Number	:	1891293338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL RYLAND BRADLEY PA-C

Provider Business Mailing Address
First Line	:	711 N TAYLOR ST
Second Line	:
City	:	GUNNISON
State	:	CO
Zip	:	81230-2208
Country	:	US
Telephone Number	:	970-641-1456
Fax Number	:	970-641-4461

Provider Business Practice Location Address
First Line	:	12 SNOWMASS RD
Second Line	:	AXTEL 100
City	:	CRESTED BUTTE
State	:	CT
Zip	:	81225-1850
Country	:	US
Telephone Number	:	970-349-0321
Fax Number	:	970-349-0328

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

Provider Enumeration Date	:	01/30/2018
Last Update Date	:	05/19/2023

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