Provider Demographics
NPI:1265939185
Name:BRADLEY, KIMBERLY L (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 SW BERTHA BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2096
Mailing Address - Country:US
Mailing Address - Phone:888-984-7277
Mailing Address - Fax:833-989-2307
Practice Address - Street 1:1340 SW BERTHA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2096
Practice Address - Country:US
Practice Address - Phone:888-984-7277
Practice Address - Fax:833-989-2307
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201807766NP363LP2300X, 363LF0000X, 261QU0200X
CA95010714363LP2300X, 363LC1500X
TX884419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty