Provider Demographics
NPI:1386954956
Name:BRADLEY JELLERICHS ARNP PLLC
Entity type:Organization
Organization Name:BRADLEY JELLERICHS ARNP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:JELLERICHS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-251-2688
Mailing Address - Street 1:1100 BELLEVUE WAY NE STE 8A-324
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4280
Mailing Address - Country:US
Mailing Address - Phone:253-251-2688
Mailing Address - Fax:844-360-4367
Practice Address - Street 1:34616 11TH PL S STE 2
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8705
Practice Address - Country:US
Practice Address - Phone:253-251-2688
Practice Address - Fax:425-440-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X
WA603049127261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty