Provider Demographics
NPI:1659701415
Name:BRADFORD, RHONDA (NP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4949
Mailing Address - Country:US
Mailing Address - Phone:214-298-3817
Mailing Address - Fax:
Practice Address - Street 1:12221 MERIT DR STE 1610
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2204
Practice Address - Country:US
Practice Address - Phone:214-217-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653164363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330181402Medicaid
TX330181401Medicaid
TX334768YP79Medicare PIN
TX334768YP78Medicare PIN