Healthcare Provider Details

I. General information

NPI: 1821916560
Provider Name (Legal Business Name): TREY J BRADLEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

V. Phone/Fax

Practice location:
  • Phone: 812-331-3400
  • Fax: 812-332-7265
Mailing address:
  • Phone: 812-331-3400
  • Fax: 812-332-7265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71018212A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: