Individual provider Active NPI

Kelia Kimesha Bradshaw, CRNP

  • Nurse Practitioner
  • Erie, PA
National Provider Identifier
1174301287
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP028205 Issued in PA
Practice address
120 E 2ND St FL 2
Erie, PA 16507-1579
Phone
(814) 456-8980
Fax
(814) 451-0443
NPI assigned
Sep 19, 2023
Last updated
Feb 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X SP028205 PA Primary

Addresses

Primary practice location

120 E 2ND St FL 2
Erie, PA 16507-1579

Mailing address

120 E 2ND St FL 2
Erie, PA 16507-1579
Phone (814) 456-8980

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelia.bradshaw@upmcdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240126004221 PA Practitioner - Nurse Practitioner 3971956814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regional Health Services IncGroup PAC ID 4880593722, 572 clinicians

Practice addresses (Care Compare)

120 E 2ND St
FL2 Upmc Heart and Vascular Institute
Erie, PA 16507-1537
Phone (814) 456-8980

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP028205PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Health Services Inc CurrentSince Dec 31, 2023 Accepting new patients

Locations

120 E 2nd St
Fl 2
Erie, PA 16507
Phone (814) 877-9700

201 State St
Erie, PA 16550
Phone (814) 877-2137

3406 Peach St
Erie, PA 16508
Phone (814) 877-5381

2 Hot Metal St
Bldg 3RD
Pittsburgh, PA 15203

Interoperability endpoints

  • Direct secure messaging: kbradshaw44438@upmc.direct-ci.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1174301287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 E 2ND ST FL 2",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071579",
            "telephone_number": "814-456-8980",
            "fax_number": "814-451-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E 2ND ST FL 2",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165071579",
            "telephone_number": "814-456-8980",
            "fax_number": "814-451-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "KELIA",
        "middle_name": "KIMESHA",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-19",
        "last_updated": "2024-02-20",
        "certification_date": "2023-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP028205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelia.bradshaw@upmcdirect.com",
            "affiliation": "N",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.