Provider Demographics
NPI:1447770870
Name:BRADLEY, KEVIN ALAN (LPN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALAN
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HANCOCK PL NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3321
Mailing Address - Country:US
Mailing Address - Phone:571-214-9871
Mailing Address - Fax:
Practice Address - Street 1:180 GRAFTON LN
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-2576
Practice Address - Country:US
Practice Address - Phone:540-955-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002083020164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse