Individual
KATHERINE ELAINE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
615 VOLUNTEER PARKWAY, BRISTOL, TN 37620
(423) 989-3223
Mailing address
1642 SNOWFLAKE RD, GATE CITY, VA 24251-4142
(423) 963-0016
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0017138087
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020684999
TAX ID
VA
05
—
4046961
—
TN
01
—
4100703
BLUE CROSS/BLUE SHIELD
TN
05
—
4401061
—
TN
01
—
DA3103
RAILROAD MEDICARE
VA
01
—
TN0103
JOHN DEERE
VA
Enumeration date
10/04/2006
Last updated
09/12/2014
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