Crystal Bradley, FNP-C, FPA

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277.003238 Issued in IL

Practice address

4260 S State Route 159 Ste 1
Glen Carbon, IL 62034-3201

Phone

(872) 713-7614

NPI assigned

Nov 5, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1306447263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4335 WAGNER RD",
            "city": "MARINE",
            "state": "IL",
            "postal_code": "620611253",
            "telephone_number": "314-306-5239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 S STATE ROUTE 159 STE 1",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343201",
            "telephone_number": "872-713-7614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "CRYSTAL",
        "credential": "FNP-C, FPA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-05",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277.003238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crystal.thedripbar@outlook.com",
            "affiliation": "Y",
            "affiliationName": "THE DRIPBar Edwardsville Glen Carbon",
            "address_1": "4260 S State Route 159 Ste 1",
            "city": "Glen Carbon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620343201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric Joseph Bomba
• Amber Bond
• Patricia Bortko
• Paige Hope Bowman
• Connor Joseph Bradley, DC
• Todd M Brammeier, D.M.D.
• Rebecca Allison Brand, LCPC
• Briana L. Oller, D.M.D., P.C.
• Rachel Ohannah Britton, RBT
• Kennedi Brown

• Family Nurse Practitioner in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Family Nurse Practitioner in Illinois

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