Provider Demographics
NPI:1396929113
Name:BRAWLEY, KATHY GAIL
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:GAIL
Last Name:BRAWLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:GAIL
Other - Last Name:BRAWLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT,CT,MR
Mailing Address - Street 1:1016 M8 RD
Mailing Address - Street 2:PO BOX 121
Mailing Address - City:MACK
Mailing Address - State:CO
Mailing Address - Zip Code:81525
Mailing Address - Country:US
Mailing Address - Phone:970-858-0867
Mailing Address - Fax:
Practice Address - Street 1:1016 M8 RD
Practice Address - Street 2:
Practice Address - City:MACK
Practice Address - State:CO
Practice Address - Zip Code:81525
Practice Address - Country:US
Practice Address - Phone:970-858-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1862642471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
186264OtherARRT