Bradley Dean Bostic, CNP
Individual provider Active NPI Adult Health Nurse Practitioner · Ashland, OH
NPI 1467729202 · NPPES record last updated Nov 21, 2016
Key facts
- NPI
- 1467729202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 359240 (OH)
- Practice address
- 1050 Dauch Dr
Ashland, OH 44805-8845 - Phone
- (419) 685-3369
- NPI assigned
- Nov 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120525000162 | OH | Practitioner - Nurse Practitioner | 4385807536 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 359240 | OH | MD | Adult Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 359240 | OH | Yes |
Addresses
Primary practice location
1050 Dauch Dr
Ashland, OH 44805-8845
Mailing address
626 Lexington Ontario Rd
Mansfield, OH 44903-7563
Phone (419) 685-3369
Other providers in Ashland, OH
- Jennifer Marie Boerwinkle
- Bernadette E Bogner
- Anita A. Bojtos
- Cherisse Elana Booth
- Cassi Borchart
- Derrick Bowersock
- Amanda Lynn Bowling
- Amanda Bowman
- Victoria Bowman
- Beth A Boyd
All providers in Ashland, OH · Adult Health Nurse Practitioner in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.