Provider Demographics
NPI:1144595257
Name:BRADLEY, JOHN PAUL (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8940
Mailing Address - Country:US
Mailing Address - Phone:901-591-1590
Mailing Address - Fax:
Practice Address - Street 1:7865 EDUCATORS LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-8191
Practice Address - Country:US
Practice Address - Phone:901-591-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN21539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I3361Medicare PIN