Provider Demographics
NPI:1366220808
Name:BRADLEY, HEIDI M (RN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:SEQUATCHIE
Mailing Address - State:TN
Mailing Address - Zip Code:37374-5030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8401 HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:SEQUATCHIE
Practice Address - State:TN
Practice Address - Zip Code:37374-5030
Practice Address - Country:US
Practice Address - Phone:678-687-4376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily