Provider Demographics
NPI:1427512482
Name:BRADFISCH, ASHLEY NICOLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:BRADFISCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:MATTHYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1209 PEBBLECREEK DR APT A
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9514
Mailing Address - Country:US
Mailing Address - Phone:612-839-8018
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE 209
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1149
Practice Address - Country:US
Practice Address - Phone:816-235-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013644163W00000X
MN2148805163W00000X
MO2019002363363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse