Provider Demographics
NPI:1316487358
Name:BRADFORD, RACHAEL (APRN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MORGAN CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9199
Mailing Address - Country:US
Mailing Address - Phone:859-322-0807
Mailing Address - Fax:
Practice Address - Street 1:135 E MAXWELL ST STE 402
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2617
Practice Address - Country:US
Practice Address - Phone:859-255-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner