Provider Demographics
NPI:1427625128
Name:BRADLEY, VIRGINIA FAYE (DNP PMHNP)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:FAYE
Last Name:BRADLEY
Suffix:
Gender:
Credentials:DNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-8980
Mailing Address - Country:US
Mailing Address - Phone:704-214-8660
Mailing Address - Fax:304-313-4559
Practice Address - Street 1:4445 CORPORATION LN STE 264
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3671
Practice Address - Country:US
Practice Address - Phone:276-231-1754
Practice Address - Fax:276-231-1754
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV118038363LP0808X
CA95028544363LP0808X
VA0024184968363LP0808X
CA95342351163W00000X
VA1315620163W00000X
NC214605163W00000X
TN31140363LP0808X
SC25177A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95028544OtherBOARD OF NURSING
SC25177AOtherSOUTH CAROLINA BOARD OF NURSING
CA95028544OtherNURES PRACTITIONER
VA0001315620OtherVIRGINIA BOARD OF NURSING
WV118038OtherTHE WEST VIRGINIA BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES
TN31140OtherTENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS
NC5014536OtherNORTH CAROLINA BOARD OF NURSING
VA0024184968OtherCOMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
CA95028544OtherSTATE OF CALIFORNIA BOARD OF REGISTERED NURSING