Basic Information
| Provider Information | |||||||||
| NPI: | 1689775793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAGDON | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 929 SW MULVANE ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704100 | ||||||||
| FaxNumber: | 7852704196 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 SW MULVANE ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852704100 | ||||||||
| FaxNumber: | 7852704196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 364S00000X | 74148 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
No ID Information.