Active NPI
Laura E Bradley, PAC
- Physician Assistant
- Huntington, WV
National Provider Identifier
1548200843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA456
- Practice address
- 1540 Spring Valley Dr
Huntington, WV 25704-9300 - Phone
- (606) 922-2316
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | PA456 | KY | |
| Physician Assistant | 363A00000X | PA456 | KY | Primary |
Addresses
Primary practice location
1540 Spring Valley Dr
Huntington, WV 25704-9300
Mailing address
1540 Spring Valley Dr
Huntington, WV 25704-9300
Phone (606) 922-2316
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95001376 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA456 | KY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-State Pulmonary Assoc PSC | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Pulmonary Disease Physician
- Ashland, KY
- NPI 1851498364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291766400000",
"number": "1548200843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1540 SPRING VALLEY DR",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257049300",
"telephone_number": "606-922-2316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1540 SPRING VALLEY DR",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257049300",
"telephone_number": "606-922-2316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "LAURA",
"middle_name": "E",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-07",
"last_updated": "2010-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "PA456",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KY",
"license": "PA456",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "95001376",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntington, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.