Provider Demographics
NPI:1205623105
Name:BRADLEY, SIMONE
Entity type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MIDDLETOWN COMMONS
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WHITE HALL
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:240-309-3838
Mailing Address - Fax:
Practice Address - Street 1:651 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:240-309-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula