Provider Demographics
NPI:1053119826
Name:KASPER, BRADLEY ELLIS (BS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ELLIS
Last Name:KASPER
Suffix:
Gender:
Credentials:BS
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:ELLIS
Other - Last Name:KASPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1011 SORRENTO RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2265 KRAFT DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6360
Practice Address - Country:US
Practice Address - Phone:540-231-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program