Basic Information
| Provider Information | |||||||||
| NPI: | 1215385380 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAZQUEZ | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | BRADFORD | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562655864 | ||||||||
| FaxNumber: | 2562655865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 MONROE ST SW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358015029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562655864 | ||||||||
| FaxNumber: | 2562655865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2016 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1-145099 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.