Healthcare Provider Details

I. General information

NPI: 1578024188
Provider Name (Legal Business Name): CRYSTAL SWEETING BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7929 KIRBY DR # A
HOUSTON TX
77054-1701
US

IV. Provider business mailing address

PO BOX 392929
PITTSBURGH PA
15251-9900
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: