Provider Demographics
NPI:1174353510
Name:BRADDY, GRAYSON ALEXANDRA (APRN)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:ALEXANDRA
Last Name:BRADDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3694 SHADOW CANYON TRL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5569
Mailing Address - Country:US
Mailing Address - Phone:970-402-0667
Mailing Address - Fax:
Practice Address - Street 1:3694 SHADOW CANYON TRL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-5569
Practice Address - Country:US
Practice Address - Phone:970-402-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999996-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health