Provider Demographics
NPI:1780950733
Name:BRADLEY, LAURA NUGENT (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:NUGENT
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:NUGENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 ST. VINCENT'S DRIVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1630
Mailing Address - Country:US
Mailing Address - Phone:205-933-8981
Mailing Address - Fax:205-930-0746
Practice Address - Street 1:800 ST. VINCENT'S DRIVE
Practice Address - Street 2:SUITE 700
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1630
Practice Address - Country:US
Practice Address - Phone:205-933-8981
Practice Address - Fax:205-930-0746
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-807363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical