Provider Demographics
NPI:1962282772
Name:BRADLEY, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 LEONARD LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1020
Mailing Address - Country:US
Mailing Address - Phone:406-212-2917
Mailing Address - Fax:
Practice Address - Street 1:75 CLAREMONT ST STE H
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3500
Practice Address - Country:US
Practice Address - Phone:067-527-4064
Practice Address - Fax:406-752-7544
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT131676363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant