Nicolas Bradley, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PADA1173 Issued in AK

Practice address

1301 W Parks Hwy Ste 101
Wasilla, AK 99654-6939

Phone

(073) 577-7819

Fax

(907) 745-6573

NPI assigned

Feb 18, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: nbradley1159304@ak.providencedirect.org

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1992027940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W PARKS HWY STE 101",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546939",
            "telephone_number": "073-577-7819",
            "fax_number": "907-745-6573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W PARKS HWY STE 101",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996546939",
            "telephone_number": "073-577-7819",
            "fax_number": "907-745-6573"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 W Cowles St",
            "address_purpose": "LOCATION",
            "city": "Fairbanks",
            "state": "AK",
            "postal_code": "997015926",
            "country_code": "US",
            "telephone_number": "907-451-6682",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1389 Huffman Rd",
            "address_2": "#150",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "99515",
            "country_code": "US",
            "telephone_number": "888-227-3312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 E Bogard Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Wasilla",
            "state": "AK",
            "postal_code": "996547184",
            "country_code": "US",
            "telephone_number": "907-352-2880",
            "fax_number": "907-352-2885",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Bldg 786 D St",
            "address_purpose": "LOCATION",
            "city": "JBER",
            "state": "AK",
            "postal_code": "99506",
            "country_code": "US",
            "telephone_number": "907-384-0605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "NICOLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-18",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "PADA1173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicolas.bradley.2@2839.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "950 E Bogard Rd Ste 103",
            "city": "Wasilla",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996547184",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nbradley1159304@ak.providencedirect.org",
            "affiliation": "N",
            "address_1": "1389 Huffman Rd",
            "address_2": "#150",
            "city": "Anchorage",
            "state": "AK",
            "country_code": "US",
            "postal_code": "99515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Katelyn Boyter, LMT
• Jewell Douglas Bradford
• Amanda Paige Bradley, DMD
• Elicia Bradley
• Martha Bradley
• Darian L Bragg
• Mirja Brain
• Sean Eric Braman
• Leah M Bramer, PAC
• Bryan Brandenburg, MS, LPC

• Physician Assistant in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.