Provider Demographics
NPI:1124868070
Name:BRADLEY, SIDNEY WORRELL (FNP-C)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:WORRELL
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 1:2695 L T HARDEE RD # A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-7703
Mailing Address - Country:US
Mailing Address - Phone:919-922-5845
Mailing Address - Fax:
Practice Address - Street 1:3106 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3202
Practice Address - Country:US
Practice Address - Phone:252-808-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner