Individual
KATHY Y BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1420 ROOSEVELT AVE STE 4, MOUNT VERNON, WA 98273-2687
(360) 899-4086
(360) 899-4124
Mailing address
1420 ROOSEVELT AVE STE 4, MOUNT VERNON, WA 98273-2687
(360) 899-4086
(360) 899-4124
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP60172219
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0296462
LABOR AND INDUSTRIES
WA
01
—
12194699
CAQH
WA
05
—
2024980
—
WA
Enumeration date
09/27/2010
Last updated
05/07/2020
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