Provider Demographics
NPI:1467767798
Name:BRADY, KIM C (APRN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:BRADY
Suffix:
Gender:F
Credentials:APRN
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Other - Last Name:
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Mailing Address - Street 1:185 QUEEN CITY AVE
Mailing Address - Street 2:ELLIOT ORTHOPAEDIC SURGERY SPECIALISTS
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7100
Mailing Address - Country:US
Mailing Address - Phone:603-625-1655
Mailing Address - Fax:603-626-4686
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:ELLIOT ORTHOPAEDIC SURGERY SPECIALISTS
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7100
Practice Address - Country:US
Practice Address - Phone:603-625-1655
Practice Address - Fax:603-626-4686
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH060016-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner