Provider Demographics
NPI:1275025546
Name:BRADSHAW, KERI AMANDA (NP-C)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:AMANDA
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CHATHAM SQUARE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2585
Mailing Address - Country:US
Mailing Address - Phone:540-300-6182
Mailing Address - Fax:540-301-2294
Practice Address - Street 1:406 CHATHAM SQUARE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2585
Practice Address - Country:US
Practice Address - Phone:540-300-6182
Practice Address - Fax:540-301-2294
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176451363L00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner