Maya Mikkia Bradford, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

P63115 Issued in IA

Practice address

2701 17TH St
Rock Island, IL 61201-5351

Phone

(309) 779-2031

NPI assigned

Aug 5, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• The Robert Young Center for Community Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Davenport, IA
  • NPI 1093201410
  NPD (past)

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

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564963200000",
    "number": "1346895646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 17TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015351",
            "telephone_number": "309-779-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 17TH ST",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015351",
            "telephone_number": "309-779-2031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9537 12160 utah avenue",
            "address_purpose": "LOCATION",
            "city": "Davenport",
            "state": "IA",
            "postal_code": "52804",
            "country_code": "US",
            "telephone_number": "563-326-1150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "MAYA",
        "middle_name": "MIKKIA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-05",
        "last_updated": "2019-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IA",
            "license": "P63115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy Bowers
• Martha A Bowles, MA
• Kathryn Bowman, EDS
• Samantha Bowman
• Sondra Braden, CTRS
• Bradley W. Buckrop DPM
• Shawnee Brees
• Brittany Christina Brewer, MA
• Branden Briggs, M.D.
• Jennifer Lucille Broghammer

• Licensed Practical Nurse in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Licensed Practical Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; 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.