Provider Demographics
NPI:1497239891
Name:BRADLEY, KRISTEN (APRN, AGACNP-BC,RNFA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:APRN, AGACNP-BC,RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2216
Mailing Address - Country:US
Mailing Address - Phone:409-838-0346
Mailing Address - Fax:409-813-3546
Practice Address - Street 1:3650 LAUREL ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2216
Practice Address - Country:US
Practice Address - Phone:409-838-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031536363LA2100X, 363LA2200X, 363LG0600X, 363L00000X
TX804593163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology