Provider Demographics
NPI:1659935476
Name:BRADLEY, THOMAS A (APRN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-856-2133
Practice Address - Street 1:20 WILSON FARM RD
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058
Practice Address - Country:US
Practice Address - Phone:870-895-2015
Practice Address - Fax:870-895-2164
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily