Amanda J Bradley, MSN RN

Primary specialty

Gerontology Clinical Nurse SpecialistTaxonomy code 364SG0600X

License

2023127914 Issued in MI

Practice address

205 North East Ave
5TH Floor Comprehensive Clinical Care
Jackson, MI 49201

Phone

(517) 205-7515

NPI assigned

Jul 3, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1174200968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 NORTH EAST AVE",
            "address_2": "5TH FLOOR COMPREHENSIVE CLINICAL CARE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-205-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 NORTH EAST AVE",
            "address_2": "5TH FLOOR COMPREHENSIVE CLINICAL CARE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-205-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "AMANDA",
        "middle_name": "J",
        "credential": "MSN RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704265861",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "MI",
            "license": "2023127914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Boyer
• Jane M Boyle, NP-C
• Brad E Kremer PLLC
• Bethany Ruth Bradford, DPT
• Taylor Bradish
• Chassity Bradley
• Galena S Bradley
• Jonathan F. Bradley, MD
• Keisha Bradley
• Annissa Elaine Brady

• Gerontology Clinical Nurse Specialist in Jackson, MI
• Providers in Jackson, MI by specialty
• Gerontology Clinical Nurse Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.