Individual
LAURA E BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1540 SPRING VALLEY DR, HUNTINGTON, WV 25704-9300
(606) 922-2316
Mailing address
1540 SPRING VALLEY DR, HUNTINGTON, WV 25704-9300
(606) 922-2316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA456
KY
363A00000X
Physician Assistant
Primary
PA456
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95001376
—
KY
Enumeration date
06/07/2006
Last updated
12/08/2010
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