Provider Demographics
NPI:1881299121
Name:BRADLEY, CHRISTIN JR (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:JR
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 PRESTON RD STE 244-222
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8548
Mailing Address - Country:US
Mailing Address - Phone:910-987-7304
Mailing Address - Fax:
Practice Address - Street 1:8055 WINDROSE AVE APT 4143
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0301
Practice Address - Country:US
Practice Address - Phone:910-987-7304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX019899372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion