Provider Demographics
NPI:1851873442
Name:DEMERITT, BRADLEY K (APRN)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:K
Last Name:DEMERITT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0736
Mailing Address - Country:US
Mailing Address - Phone:620-820-5428
Mailing Address - Fax:
Practice Address - Street 1:2613 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-3206
Practice Address - Country:US
Practice Address - Phone:620-902-2030
Practice Address - Fax:620-902-2034
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78360-071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily