Provider Demographics
NPI:1891293338
Name:BRADLEY, RACHEL RYLAND (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RYLAND
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2208
Mailing Address - Country:US
Mailing Address - Phone:970-641-1456
Mailing Address - Fax:970-641-4461
Practice Address - Street 1:12 SNOWMASS RD
Practice Address - Street 2:AXTEL 100
Practice Address - City:CRESTED BUTTE
Practice Address - State:CT
Practice Address - Zip Code:81225-1850
Practice Address - Country:US
Practice Address - Phone:970-349-0321
Practice Address - Fax:970-349-0328
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
COPA.0007721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant