MEDICARE: ASHLEY MANN BRADLEY PA-C

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	363A00000X	Physician Assistant	PA13489	TX

General Provider Information

NPI Number	:	1710506738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MANN BRADLEY PA-C

Provider Business Mailing Address
First Line	:	6431 FANNIN
Second Line	:	MSB 3.286
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-500-6412
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 350
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3004
Country	:	US
Telephone Number	:	832-325-7131
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/17/2026

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