Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Audrey Elise Bradford

Individual provider Physician Assistant · NPI 1578415089

Audrey Elise Bradford is a Physician Assistant in Fort Wayne, Indiana. Qualified in 2025, 1 year ago. Licensed in Indiana and Michigan.

Years since qualifying
1
Licensed in
IN, MI
In the registry since
2026
Specialties on file
2

Practice location Address checks out

1660 Broadway Ste 165
Fort Wayne, IN 46802-0011
Phone: (260) 266-9805
Fax: (260) 266-9815
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10005240A (IN)
Physician Assistant Taxonomy 363A00000X · Licence 5601013822 (MI)

Record details

NPI number1578415089
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 10, 2026
Last updated in NPPESJuly 10, 2026
Certification dateJuly 10, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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