Provider Demographics
NPI:1376543439
Name:BRADSHER, NANCY VERNON (AUD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:VERNON
Last Name:BRADSHER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1803
Mailing Address - Country:US
Mailing Address - Phone:434-799-6288
Mailing Address - Fax:434-797-3685
Practice Address - Street 1:743 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1803
Practice Address - Country:US
Practice Address - Phone:434-799-6288
Practice Address - Fax:434-797-3685
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201000465231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376543439Medicaid
VA640000032OtherMEDICARE PALMETTO GBA PTAN (DANNY W. GNEWIKOW, PH.D., LLC)
VAVAA103109OtherMEDICARE PALMETTO GBA PTAN (AUDIOLOGY HEARING AID ASSOCIATES, INC.)
VA640003590OtherMEDICARE RAILROAD PTAN - AUDIOLOGY HEARING AID ASSOCIATES, INC.
VA640003594OtherMEDICARE RAILROAD PTAN - DANNY W. GNEWIKOW, PH.D., LLC
VA248039OtherANTHEM OF VA - DANVILLE
VA9450301Medicaid
640000115Medicare ID - Type UnspecifiedTRAILBLAZER-LYNCHBURG
VA036910OtherANTHEM OF VA-LYNCHBURG
224352272OtherTRICARE
540964595OtherPRIMARY PHYSICIAN CARE-DA
541361858OtherPRIMARY PHYSICIAN CARE-LY
VA9450211Medicaid