MEDICARE: CARMYNN KAYLEEN BRADLEY CPC INTERN

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	101YM0800X	Mental Health Counselor	CI5100	NV

General Provider Information

NPI Number	:	1992436943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMYNN KAYLEEN BRADLEY CPC INTERN

Provider Business Mailing Address
First Line	:	848 N RAINBOW BLVD # 9256
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1103
Country	:	US
Telephone Number	:	725-246-9488
Fax Number	:

Provider Business Practice Location Address
First Line	:	7495 W AZURE DR STE 236
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4437
Country	:	US
Telephone Number	:	725-246-9488
Fax Number	:

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	01/16/2026

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