Active NPI
Danielle McGovern Bradshaw, D.O.
- Child & Adolescent Psychiatry Physician
- Vandalia, MO
National Provider Identifier
1710187539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 2012012825
- Practice address
- 1101 E HW 54
Womens Eastern Reception Diagnostic and Correctional Ce
Vandalia, MO 63382 - Phone
- (573) 594-6686
- NPI assigned
- Jul 19, 2007
- Last updated
- Jul 31, 2013
- 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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 2012012825 | MO | Primary |
Addresses
Primary practice location
1101 E HW 54
Womens Eastern Reception Diagnostic and Correctional Ce
Vandalia, MO 63382
Mailing address
1026 Northeast Dr
MHM Services
Jefferson City, MO 65109
Phone (573) 635-3850
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
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375228800000",
"number": "1710187539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1026 NORTHEAST DR",
"address_2": "MHM SERVICES",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "65109",
"telephone_number": "573-635-3850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 E HW 54",
"address_2": "WOMENS EASTERN RECEPTION DIAGNOSTIC AND CORRECTIONAL CE",
"city": "VANDALIA",
"state": "MO",
"postal_code": "63382",
"telephone_number": "573-594-6686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "DANIELLE",
"middle_name": "MCGOVERN",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-19",
"last_updated": "2013-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "MO",
"license": "2012012825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vandalia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.