Provider Demographics
NPI:1629834601
Name:PAULEY, BRADLEY (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:
Last Name:PAULEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22100 STATE ROUTE 245
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8005
Mailing Address - Country:US
Mailing Address - Phone:973-209-0147
Mailing Address - Fax:
Practice Address - Street 1:22100 STATE ROUTE 245
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8005
Practice Address - Country:US
Practice Address - Phone:937-209-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily