DR. BRADLEY DEE MANGUM FNP-BC DC NPI 1235465147

NPI Information

NPI: 1235465147
Provider Name: DR. BRADLEY DEE MANGUM, FNP-BC, DC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
559 W WASHINGTON ST
BURNS, OR
ZIP 97720
Phone: (541) 573-2074
Get Directions

DR. Bradley Dee Mangum, FNP-BC, DC is a family nurse practitioner in Burns, OR with 13 years of experience. DR. Bradley Dee Mangum, FNP-BC, DC NPI is 1235465147. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

559 W WASHINGTON ST
BURNS, OR
ZIP 97720-441
Phone: (541) 573-2074

The NPI 1235465147 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/27/2009 and was last updated on 12/3/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	1573A	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500763900	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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