Provider Demographics
NPI:1417295510
Name:BRADLEY, KATHRYN ANN (IBCLC, CD06)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:IBCLC, CD06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3802
Mailing Address - Country:US
Mailing Address - Phone:321-213-1112
Mailing Address - Fax:
Practice Address - Street 1:1004 GEORGE AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3802
Practice Address - Country:US
Practice Address - Phone:321-213-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 374J00000X, 172V00000X
FL10420859174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker