Individual
BRADLEY KENNETH FULLBRIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
908 W 4TH NORTH ST, MORRISTOWN, TN 37814-3894
(423) 492-6100
Mailing address
908 W 4TH NORTH ST, MORRISTOWN, TN 37814-3894
(423) 492-6100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601
TN
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q086381
—
TN
Enumeration date
05/08/2020
Last updated
10/10/2023
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