Provider Demographics
NPI:1275626913
Name:BRADLEY, STEPHANI CURTIS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANI
Middle Name:CURTIS
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 FLAG LAKE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6292
Mailing Address - Country:US
Mailing Address - Phone:979-297-8800
Mailing Address - Fax:979-297-0300
Practice Address - Street 1:120 FLAG LAKE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6292
Practice Address - Country:US
Practice Address - Phone:979-297-8800
Practice Address - Fax:979-297-0300
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX521716207Q00000X
TXAP113690363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX872241Medicare ID - Type Unspecified
TXQ36818Medicare UPIN