Kacy Lee Bradshaw, NNP

Primary specialty

Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X

License

201050101NP Issued in OR

Practice address

939 Oak St SE
Salem, OR 97301-3901

Phone

(503) 814-3561

Fax

(503) 814-3560

NPI assigned

Jul 24, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1871848457
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279929600000",
    "number": "1972816593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14001",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973095014",
            "telephone_number": "503-561-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 OAK ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013901",
            "telephone_number": "503-814-3561",
            "fax_number": "503-814-3560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "KACY",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "NNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-24",
        "last_updated": "2010-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "OR",
            "license": "201050101NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Anne Bradford
• Ty David Bradford, PA-C
• Gabriela Raquel Bradley, FNP
• Heather Bradshaw, LMFT, LPC
• John K Bradshaw, M.D.
• Leah Brakebill, SLP
• Marcus Allan Braman, MD
• Erika Branch
• Branches of Change Counseling LLC
• Elizabeth Brandriet, PT

• Critical Care Neonatal Nurse Practitioner in Salem, OR
• Providers in Salem, OR by specialty
• Critical Care Neonatal Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.