Individual
ROBERT BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN-CNP
Contact information
Practice address
525 S SCHWARTZ AVE, FARMINGTON, NM 87401-5955
(505) 609-2000
Mailing address
3701 SIERRA VISTA DR, FARMINGTON, NM 87402-8356
(405) 574-5715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
53-78499-102
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53-78499-102
KANSAS STATE BOARD OF NURSING
KS
Enumeration date
04/26/2020
Last updated
04/26/2020
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