William Bradley, FNP
Individual provider Active NPI Family Nurse Practitioner · Sikeston, MO
NPI 1649375940 · NPPES record last updated Jun 8, 2015
Key facts
- NPI
- 1649375940
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 131573 (MO)
- Practice address
- 200 Southland Dr
Sikeston, MO 63801-4403 - Phone
- (573) 427-1770
- Fax
- (573) 472-4050
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Columbia University College of Physicians and Surgeons, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Health Facilities Rehab Services Inc
Southeast Missouri Health Network
Practice addresses (Care Compare)
1102 Sikes Ave
Sikeston, MO 63801-5021
200 Southland Dr
Sikeston, MO 63801-4403
Phone (573) 472-1770
Hospital & facility affiliations
- Missouri Delta Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- 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 |
|---|---|---|---|---|
| I20050214000184 | MO | Practitioner - Nurse Practitioner | 3375595804 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 131573 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Missouri Health Network | Current | Accepting new patients | |
| Southeast Missouri Health Network | Current |
Accepting new patients | |
| Southeast Missouri Health Network | Past | Accepting new patients | |
| Southeast Missouri Health Network | Past | Accepting new patients |
Locations
6738 State Highway 77
Benton, MO 63736
Phone (573) 313-2500
421 Semo Dr
New Madrid, MO 63869
Phone (573) 748-2592
420 Semo Dr
New Madrid, MO 63869
655 US Highway 61
New Madrid, MO 63869
Phone (573) 545-4200
200 Southland Dr
Sikeston, MO 63801
Phone (573) 472-1770
Interoperability endpoints
- william.bradley.1@14764.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 131573 | MO | Yes |
Addresses
Primary practice location
200 Southland Dr
Sikeston, MO 63801-4403
Mailing address
420 Semo Dr
P O Box 400
New Madrid, MO 63869-1734
Phone (573) 748-2404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 427752506 | Medicaid | MO |
Other providers in Sikeston, MO
- Bootheel Counseling Services
- Hailey Jean Borden
- Brittan Rachel Bossert
- Tiffani Bowman
- Charles William Boyce
- Morgan Lindsey Brasher
- Bruce A Braswell
- Alicia Marie Brinkman
- Ronald L Brinkmeyer
- Taylor Ann Brotherton
All providers in Sikeston, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2015. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.