Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 95010714 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 201807766NP | OR |
N | 363LP2300X | Nurse Practitioner - Primary Care | 201807766NP | OR |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95010714 | CA |
NPI | 1265939185 |
---|---|
Provider Name | Mrs. Kimberly L. Bradley |
First Address | Fresno, CA 93711-6686 |
Second Address | Madera, CA 93638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2018 |
Last Update Date | 06/07/2021 |