Provider Demographics
NPI:1295504850
Name:BRADLEY, HEATHER (PMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S ARIZONA PL STE 500
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8520
Mailing Address - Country:US
Mailing Address - Phone:480-420-4656
Mailing Address - Fax:844-430-0223
Practice Address - Street 1:25 S ARIZONA PL STE 500
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8520
Practice Address - Country:US
Practice Address - Phone:480-420-4656
Practice Address - Fax:844-430-0223
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ301534363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health