Ryan Bradley, PA-C, CAQ-PSY

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9118992 Issued in FL

Practice address

4315 El Salvador Way
Eglin, FL 32542-1711

Phone

(575) 386-6585

NPI assigned

Jul 7, 2022

Last updated

Oct 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Dragonfly Behavioral Health Services LLC

  dba Dragonfly Behavioral Health Services

  • Psychiatry Physician
  • Shalimar, FL
  • NPI 1467271692
  NPD Authorized official

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1235862012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "915-742-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 EL SALVADOR WAY",
            "city": "EGLIN",
            "state": "FL",
            "postal_code": "325421711",
            "telephone_number": "575-386-6585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6600 Van Aalst Blvd",
            "address_purpose": "LOCATION",
            "city": "Fort Moore",
            "state": "GA",
            "postal_code": "319052102",
            "country_code": "US",
            "telephone_number": "915-742-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 11th Ave Ste A2",
            "address_purpose": "LOCATION",
            "city": "Shalimar",
            "state": "FL",
            "postal_code": "325791318",
            "country_code": "US",
            "telephone_number": "850-790-9621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C, CAQ-PSY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-07",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9118992",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "1198847",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Margaret Baker-Janis, NP
• Amanda Bell
• Biloxi Vamc
• Heather Dawn Brock
• Wesley Cole
• Deana Joy Dogherra, IDMT
• Joel Evan Elliott, CRNA
• Christopher James Gardner, PA-S, NREMT

• Medical Physician Assistant in Eglin, FL
• Providers in Eglin, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.