Active NPI
Coreena J Bradley, LPN
- Licensed Practical Nurse
- Evanston, WY
National Provider Identifier
1619257540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 245
- Practice address
- 75 Yellow Creek Rd
Ste 105
Evanston, WY 82930-5235 - Phone
- (307) 789-4224
- Fax
- (307) 789-4225
- NPI assigned
- Aug 23, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 245 | WY | Primary |
Addresses
Primary practice location
75 Yellow Creek Rd
Ste 105
Evanston, WY 82930-5235
Mailing address
75 Yellow Creek Rd
Ste 105
Evanston, WY 82930-5235
Phone (307) 789-4224
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 245 | WY | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| High Country Behavioral Health | 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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Evanston, WY
- NPI 1891099545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314057600000",
"number": "1619257540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 YELLOW CREEK RD",
"address_2": "STE 105",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829305235",
"telephone_number": "307-789-4224",
"fax_number": "307-789-4225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 YELLOW CREEK RD",
"address_2": "STE 105",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829305235",
"telephone_number": "307-789-4224",
"fax_number": "307-789-4225"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "COREENA",
"middle_name": "J",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-23",
"last_updated": "2011-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WY",
"license": "245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.