Active NPI
Allison Lynn Bradshaw, PA
- Physician Assistant
- Randolph Afb, TX
National Provider Identifier
1992789846
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1068209
- Practice address
- 221 3Rd St W
Building 1040
Randolph Afb, TX 78150-4800 - Phone
- (701) 723-5199
- NPI assigned
- Dec 5, 2005
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1068209 | ND | Primary |
Addresses
Primary practice location
221 3Rd St W
Building 1040
Randolph Afb, TX 78150-4800
Mailing address
73 Main Cir Ste 1
Randolph Afb, TX 78150-4543
Phone (701) 721-1500
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1068209 | ND | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362355200000",
"number": "1992789846",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "73 MAIN CIR STE 1",
"city": "RANDOLPH AFB",
"state": "TX",
"postal_code": "781504543",
"telephone_number": "701-721-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 3RD ST W",
"address_2": "BUILDING 1040",
"city": "RANDOLPH AFB",
"state": "TX",
"postal_code": "781504800",
"telephone_number": "701-723-5199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "ALLISON",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-05",
"last_updated": "2013-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ND",
"license": "1068209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randolph Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.