Individual
ALICON KAY BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
4601 CHAMBERLAIN LN, LOUISVILLE, KY 40241-1159
(502) 384-2844
Mailing address
4601 CHAMBERLAIN LN, LOUISVILLE, KY 40241-1159
(502) 384-2844
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
3006770
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100231860
—
KY
Enumeration date
12/27/2012
Last updated
08/09/2013
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