Provider Demographics
NPI:1902545809
Name:BRADFIELD, MIRANDA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:
Last Name:BRADFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1147 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3532
Mailing Address - Country:US
Mailing Address - Phone:316-304-3329
Mailing Address - Fax:
Practice Address - Street 1:8338 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2979
Practice Address - Country:US
Practice Address - Phone:316-215-8339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81155-111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-81155-111OtherNURSE PRACTITIONER LICENSE NUMBER