MEDICARE: TERESA NICOLE BRADLEY CLC, LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	333764

General Provider Information

NPI Number	:	1043154230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA NICOLE BRADLEY CLC, LVN

Provider Business Mailing Address
First Line	:	708 LINE DR
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-5130
Country	:	US
Telephone Number	:	940-443-2243
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 LINE DR
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-5130
Country	:	US
Telephone Number	:	940-443-2243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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