Provider Demographics
NPI:1851875892
Name:WATKINS - BRADLEY, ANITRA L (FNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:ANITRA
Middle Name:L
Last Name:WATKINS - BRADLEY
Suffix:
Gender:F
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 1:8984 MARINETTE PL
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8005
Mailing Address - Country:US
Mailing Address - Phone:518-209-8132
Mailing Address - Fax:
Practice Address - Street 1:3455 MILL RUN DR STE 310
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9082
Practice Address - Country:US
Practice Address - Phone:833-358-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00024523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner