Provider Demographics
NPI:1124515663
Name:BRADLEY, LASHONDA LASHAY (FNP-C)
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:LASHAY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7203
Mailing Address - Country:US
Mailing Address - Phone:662-592-2038
Mailing Address - Fax:
Practice Address - Street 1:1967 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7203
Practice Address - Country:US
Practice Address - Phone:662-624-5481
Practice Address - Fax:662-621-1499
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily