Provider Demographics
NPI:1093400632
Name:BRADFORD, KARA (RN-BSN FNP-STUDENT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:RN-BSN FNP-STUDENT
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:MARCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-BSN
Mailing Address - Street 1:446 LUDWIG DR
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9397
Mailing Address - Country:US
Mailing Address - Phone:719-291-6656
Mailing Address - Fax:
Practice Address - Street 1:1 MERCADO ST STE 160
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7309
Practice Address - Country:US
Practice Address - Phone:970-385-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998793-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily