Provider Demographics
NPI:1619160454
Name:BRADLEY, KRISTIN CAROLYN (FNP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:CAROLYN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 W MIDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1632
Mailing Address - Country:US
Mailing Address - Phone:303-438-4436
Mailing Address - Fax:303-438-4437
Practice Address - Street 1:2555 W MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1632
Practice Address - Country:US
Practice Address - Phone:303-438-4436
Practice Address - Fax:303-438-4437
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335219363LF0000X
CO990147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily