Provider Demographics
NPI:1043551237
Name:BRAGDON, KIM E (APRN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:E
Last Name:BRAGDON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11875 S SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2793
Mailing Address - Country:US
Mailing Address - Phone:913-477-8351
Mailing Address - Fax:913-826-1300
Practice Address - Street 1:11875 S SUNSET DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-2793
Practice Address - Country:US
Practice Address - Phone:913-477-8351
Practice Address - Fax:913-826-1300
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1345168092363LX0001X
KS5344304092363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology