Provider Demographics
NPI:1437938495
Name:BRADLEY, PAMELA ANNETTE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNETTE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 JUDSON RD STE 150
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5120
Mailing Address - Country:US
Mailing Address - Phone:903-234-8755
Mailing Address - Fax:
Practice Address - Street 1:1125 JUDSON RD STE 150
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5120
Practice Address - Country:US
Practice Address - Phone:903-234-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX850765163WP0808X
TX1141257363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health