Provider Demographics
NPI:1831673821
Name:BRADSHAW, KATHRYN MONET (FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MONET
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MCDOWELL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-6008
Mailing Address - Country:US
Mailing Address - Phone:805-896-3246
Mailing Address - Fax:
Practice Address - Street 1:1105 MCDOWELL DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-6008
Practice Address - Country:US
Practice Address - Phone:805-896-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBRAD-MAE3HM363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily