Provider Demographics
NPI:1598774093
Name:BRADLEY, GLENDA ANNETTE (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:ANNETTE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:APRN-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 CYPRESS STATION DR
Mailing Address - Street 2:STE B-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3054
Mailing Address - Country:US
Mailing Address - Phone:281-586-7880
Mailing Address - Fax:
Practice Address - Street 1:1125 CYPRESS STATION DR
Practice Address - Street 2:STE B-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3054
Practice Address - Country:US
Practice Address - Phone:281-586-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX525236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891756-02Medicaid