Healthcare Provider Details

I. General information

NPI: 1346856309
Provider Name (Legal Business Name): VICTORIA RENEA BRADSHAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6254 DIXIE ST
BASTROP LA
71220-9643
US

IV. Provider business mailing address

6254 DIXIE ST
BASTROP LA
71220-9643
US

V. Phone/Fax

Practice location:
  • Phone: 318-805-6450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number223653
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: