Provider Demographics
NPI:1083152722
Name:BRADLEY, KRISTYN (BS)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:904-602-9740
Mailing Address - Fax:904-637-4724
Practice Address - Street 1:1567 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4510
Practice Address - Country:US
Practice Address - Phone:904-602-9740
Practice Address - Fax:904-637-4724
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health