Provider Demographics
NPI:1508440173
Name:BRADFORD, EMERI JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMERI
Middle Name:JEAN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FALLING LEAVES DR
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2623
Mailing Address - Country:US
Mailing Address - Phone:210-410-3231
Mailing Address - Fax:
Practice Address - Street 1:200 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3963
Practice Address - Country:US
Practice Address - Phone:817-488-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant