Provider Demographics
NPI:1225453699
Name:BRADY, JENNY R (DNP, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:R
Last Name:BRADY
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N ALMA SCHOOL RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4363
Mailing Address - Country:US
Mailing Address - Phone:480-641-1165
Mailing Address - Fax:480-641-1165
Practice Address - Street 1:335 N ALMA SCHOOL RD STE E
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4363
Practice Address - Country:US
Practice Address - Phone:480-641-1165
Practice Address - Fax:480-641-9026
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF0113011363LF0000X
AZRN196906363LF0000X
AK1416363LF0000X
AZAP7319363LF0000X, 363LP0808X
WAAP61441844363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ967679Medicaid
AK1610571Medicaid