Provider Demographics
NPI:1154846566
Name:BRADLEY, PAMELA DENISE (AGNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DENISE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2511 WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265
Mailing Address - Country:US
Mailing Address - Phone:336-410-3351
Mailing Address - Fax:
Practice Address - Street 1:2806 RANDLEMAN RD STE J
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5266
Practice Address - Country:US
Practice Address - Phone:336-907-7201
Practice Address - Fax:336-907-7208
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC151422163W00000X
NC5010113363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC151422OtherREGISTERED NURSE