Provider Demographics
NPI:1942221445
Name:BRADLEY-GENTRY, DONNA E (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:E
Last Name:BRADLEY-GENTRY
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 ROCKWALL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6871
Mailing Address - Country:US
Mailing Address - Phone:214-771-3712
Mailing Address - Fax:214-771-3796
Practice Address - Street 1:890 ROCKWALL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6871
Practice Address - Country:US
Practice Address - Phone:214-771-3712
Practice Address - Fax:214-771-3796
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX575062363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N4488OtherBCBSTX
TXQ04899Medicare UPIN
TX8N4488OtherBCBSTX
TXTXB142138Medicare PIN
TXTXB142135Medicare PIN
TXTXB142137Medicare PIN