Basic Information
| Provider Information | |||||||||
| NPI: | 1902445935 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRAD HARRELL, DNP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 LACKEY LN | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380631619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314606043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 233 LACKEY LN | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380631619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314606043 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2019 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | HARRELL | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7314606043 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DNP, APRN, ACNP-BC | ||||||||
| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.