Provider Demographics
NPI:1518335058
Name:MACKEY, BRADLEY (CRNP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:MACKEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MILLERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1348
Mailing Address - Country:US
Mailing Address - Phone:412-692-3145
Mailing Address - Fax:412-692-8814
Practice Address - Street 1:11279 PERRY HWY
Practice Address - Street 2:SUITE 450
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9381
Practice Address - Country:US
Practice Address - Phone:724-933-1100
Practice Address - Fax:724-933-1160
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner