Provider Demographics
NPI:1336285162
Name:BRADY, BRIDGET
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 362
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0362
Mailing Address - Country:US
Mailing Address - Phone:901-373-9104
Mailing Address - Fax:901-255-5223
Practice Address - Street 1:3725 CHAMPION HILLS DR
Practice Address - Street 2:#2000
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2597
Practice Address - Country:US
Practice Address - Phone:901-376-9001
Practice Address - Fax:901-565-8787
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90728363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health