Provider Demographics
NPI:1316933237
Name:REA, JAMES BRADLEY (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRADLEY
Last Name:REA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6001 SW 6TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615-1011
Mailing Address - Country:US
Mailing Address - Phone:785-233-7491
Mailing Address - Fax:785-233-3187
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615-1011
Practice Address - Country:US
Practice Address - Phone:785-233-7491
Practice Address - Fax:785-233-3187
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1500380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100340710AMedicaid
KSR32023Medicare UPIN
KS023160Medicare PIN