Kimberly Ross Foncham Bradley, ARNP
Individual provider Active NPI Family Nurse Practitioner · Fort Pierce, FL
NPI 1750773255 · NPPES record last updated Feb 16, 2022
Key facts
- NPI
- 1750773255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- ARNP 9187855 (FL)
- Practice address
- 2940 S US Highway 1
Ste C11
Fort Pierce, FL 34982-8143 - Phone
- (772) 466-6855
- Fax
- (772) 464-4963
- NPI assigned
- Feb 21, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Medfast Urgent Care Centers LLC
Practice addresses (Care Compare)
2113 Sarno Rd
Melbourne, FL 32935-3001
Phone (321) 676-0558
2500 Minton Rd
West Melbourne, FL 32904-6602
Phone (321) 633-3278
390 N Courtenay Pkwy
Merritt Island, FL 32953-3456
Phone (321) 633-3162
5005 Port St John Pkwy
Port St John, FL 32927-4305
Phone (321) 757-7222
Hospital & facility affiliations
- Cleveland Clinic Indian River Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- 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 |
|---|---|---|---|---|
| I20150723009451 | FL | Practitioner - Nurse Practitioner | 2860705548 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9187855 | FL | MD | Registered Nurse |
| ARNP 9187855 | FL | MD | Family Nurse Practitioner |
Practice roles (6 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inpatient Consultants of Florida, Inc | Current | Accepting new patients | |
| Medfast Urgent Care Centers, LLC | Current |
Accepting new patients | |
| Inpatient Consultants of Florida Inc | Current |
Accepting new patients | |
| First Choice Healthcare and Counseling, LLC | Current |
Accepting new patients | |
| Medfast Urgent Care Centers, LLC | Current |
Accepting new patients | |
| Ante Rudez MD PA | Past | Accepting new patients |
Locations
608 S US Highway 1
Fort Pierce, FL 34950
Phone (772) 216-6750
7970 N Wickham Rd
Melbourne, FL 32940
Phone (321) 255-7711
2001 W 68th St
Miami Lakes, FL 33016
Phone (305) 364-2151
350 7th St N
Naples, FL 34102
Phone (239) 436-5000
5005 Port St John Pkwy
Port St John, FL 32927
Phone (321) 504-0556
2155 SE Federal Hwy
Stuart, FL 34994
Phone (772) 223-9630
3030 W Bearss Ave
Tampa, FL 33618
Phone (813) 932-2222
13806 N 46th St
Tampa, FL 33613
Phone (813) 345-5616
Networks
- Freedom Health HMO Network
Interoperability endpoints
- kimberly.foncham.bradley.1@30520.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 9187855 | FL | |
| Family Nurse Practitioner | 363LF0000X | ARNP 9187855 | FL | Yes |
Addresses
Primary practice location
2940 S US Highway 1
Ste C11
Fort Pierce, FL 34982-8143
Mailing address
2940 S US Highway 1
Ste C11
Fort Pierce, FL 34982-8143
Phone (772) 466-6855
Other providers in Fort Pierce, FL
- Florida Woman Care LLC
- Florida Woman Care LLC
- Florida Woman Care, LLC
- Focused ABA LLC
- Nila Folkes
- Forever Loving Hands, Inc
- Fort Pierce Discount Pharmacy, Inc.
- Fort Pierce Family Care, Inc.
- Fort Pierce Health Care Associates LLC
- Fort Pierce Intermediate Care Center
All providers in Fort Pierce, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2022. 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.