MR. RYAN BRADLEY PA-C CAQ-PSY NPI 1235862012

NPI Information

  • NPI: 1235862012
  • Provider Name: MR. RYAN BRADLEY, PA-C, CAQ-PSY
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4315 EL SALVADOR WAY
    EGLIN, FL
    ZIP 32542
  • Phone: (575) 386-6585

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NPI Details

MR. Ryan Bradley, PA-C, CAQ-PSY is a medical physician assistant in Eglin, FL. MR. Ryan Bradley, PA-C, CAQ-PSY NPI is 1235862012. 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:

4315 EL SALVADOR WAY
EGLIN, FL
ZIP 32542-711
Phone: (575) 386-6585

The NPI 1235862012 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 7/7/2022 and was last updated on 10/4/2024.

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
1363AM0700XPhysician AssistantMedical9118992FLORIDAYes
2363A00000XPhysician Assistant1198847TEXASNo

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
1B224-972-93-800-0OTHERFLORIDASTATE DRIVERS LICENSE

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: 11/21/2025

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