Provider Demographics
NPI:1124064068
Name:BRADLEY, BARBARA ANN (CFNP)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8681
Mailing Address - Country:US
Mailing Address - Phone:601-575-3392
Mailing Address - Fax:
Practice Address - Street 1:587 HIGHWAY 51 STE T
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2567
Practice Address - Country:US
Practice Address - Phone:601-790-7711
Practice Address - Fax:601-790-7712
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR762681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07605321Medicaid
MS07605321Medicaid
MS50000211Medicare PIN
MSP03804Medicare UPIN
MS251933Medicare Oscar/Certification
MS251850Medicare Oscar/Certification
MS251936Medicare Oscar/Certification