Healthcare Provider Details

I. General information

NPI: 1902677396
Provider Name (Legal Business Name): BRADLEY JOHN HIX DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NORTH RD STE 101
FENTON MI
48430-2668
US

IV. Provider business mailing address

2500 NORTH RD STE 101
FENTON MI
48430-2668
US

V. Phone/Fax

Practice location:
  • Phone: 810-616-7246
  • Fax: 855-709-6655
Mailing address:
  • Phone: 810-616-7246
  • Fax: 855-709-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704281484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: