1578330635 NPI number — HALEY KIRKLAND BRADSHAW MSN, APRN, FNP-C

Table of content: HALEY KIRKLAND BRADSHAW MSN, APRN, FNP-C (NPI 1578330635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578330635 NPI number — HALEY KIRKLAND BRADSHAW MSN, APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADSHAW
Provider First Name:
HALEY
Provider Middle Name:
KIRKLAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578330635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 COUNTY ROAD 501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELBA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36323-5887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-406-5035
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2431 W MAIN ST STE 1102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-1250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-944-2275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F11230241 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com