Provider Demographics
NPI:1841436417
Name:JELLERICHS, BRADLEY GAIL (ARNP)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:GAIL
Last Name:JELLERICHS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 BELLEVUE WAY NE
Mailing Address - Street 2:STE 8A PMB 324
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5721
Mailing Address - Country:US
Mailing Address - Phone:425-835-3394
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E STE 8
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60128753207QA0401X, 207N00000X
WARN 60023039163W00000X
WAAP60128753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No207N00000XAllopathic & Osteopathic PhysiciansDermatology