DELESA GABRIELLE BRADLEY


Address: 1602 S Jackson St, Jacksonville, TX 75766-3028
Phone: 4302054150

DELESA GABRIELLE BRADLEY (NPI# 1114576881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1114576881
Entity Type Individual
Full Name DELESA GABRIELLE BRADLEY
Credential APRN
Practice Address 1602 S Jackson St
Jacksonville
TX 75766-3028
Mailing Address 1018 N Mound St Ste 205
Nacogdoches
TX 75961-4434
Practice Telephone 4302054150
Mailing Telephone 9365605200
Mailing Fax Number 9365605222
Enumeration Date 2019-09-05
Last Update Date 2020-10-21
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363L00000X Nurse Practitioner AP142151 TX Physician Assistants & Advanced Practice Nursing Providers
Y 363LF0000X Nurse Practitioner
Specialization: Family
AP142151 TX Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
1018 N Mound St Ste 205, Nacogdoches, TX 759614434 9365605200 9365605222

Office Location

Street Address 1602 S JACKSON ST
City JACKSONVILLE
State TX
Zip Code 75766-3028

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Taxonomy Information

Taxonomy Code 363LF0000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Family

Taxonomy Definition

Definition to come...

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Competitor

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City JACKSONVILLE
Zip Code 75766

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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