Provider Demographics
NPI:1689007049
Name:BRADSHAW, KARI LOWERY (NP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LOWERY
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1976
Mailing Address - Country:US
Mailing Address - Phone:229-883-4555
Mailing Address - Fax:229-888-0063
Practice Address - Street 1:414 5TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1976
Practice Address - Country:US
Practice Address - Phone:229-883-4555
Practice Address - Fax:229-888-0063
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172617363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003167728AMedicaid