Active NPI
Diedra Bradley, LMSW
- Social Worker
- Fort Smith, AR
National Provider Identifier
1801179387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 2513-M
- Practice address
- 100 Towson Ave
Fort Smith, AR 72901-2632 - Phone
- (479) 784-9801
- Fax
- (479) 784-9805
- NPI assigned
- Sep 21, 2011
- Last updated
- Sep 21, 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 2513-M | AR | Primary |
Addresses
Primary practice location
100 Towson Ave
Fort Smith, AR 72901-2632
Mailing address
100 Towson Ave
Fort Smith, AR 72901-2632
Phone (479) 784-9801
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 |
|---|---|---|---|
| 2513-M | AR | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maxus Inc. | Past | Accepting new patients | |
| Maxus Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316563200000",
"number": "1801179387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 TOWSON AVE",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729012632",
"telephone_number": "479-784-9801",
"fax_number": "479-784-9805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 TOWSON AVE",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729012632",
"telephone_number": "479-784-9801",
"fax_number": "479-784-9805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "DIEDRA",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-21",
"last_updated": "2011-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "AR",
"license": "2513-M",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.