Provider Demographics
NPI:1083338370
Name:BRADDY, NATASHA ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:ANN
Last Name:BRADDY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CRABAPPLE CT
Mailing Address - Street 2:
Mailing Address - City:REHOBETH
Mailing Address - State:AL
Mailing Address - Zip Code:36301-9237
Mailing Address - Country:US
Mailing Address - Phone:334-796-4869
Mailing Address - Fax:
Practice Address - Street 1:2812 HARTFORD HWY STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4927
Practice Address - Country:US
Practice Address - Phone:334-712-1170
Practice Address - Fax:334-460-8391
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-180685363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health