Provider Demographics
NPI:1972911626
Name:BRADSHAW, JESSICA (A-GNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2849 LAWYER RD
Mailing Address - Street 2:
Mailing Address - City:MCGAHEYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22840-2734
Mailing Address - Country:US
Mailing Address - Phone:540-383-3263
Mailing Address - Fax:
Practice Address - Street 1:1046 TULIP TER
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5324
Practice Address - Country:US
Practice Address - Phone:540-421-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171891363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health