Provider Demographics
NPI:1598852196
Name:CONSEEN-BRADLEY, DEBORAH KELLIDE (FNP, GNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KELLIDE
Last Name:CONSEEN-BRADLEY
Suffix:
Gender:F
Credentials:FNP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CASINO DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719
Mailing Address - Country:US
Mailing Address - Phone:828-497-8642
Mailing Address - Fax:
Practice Address - Street 1:777 CASINO DR
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-9761
Practice Address - Country:US
Practice Address - Phone:828-497-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN10880363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ53687Medicare UPIN