Healthcare Provider Details

I. General information

NPI: 1598286734
Provider Name (Legal Business Name): STEPHANIE BRADLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE KAY FORD APRN

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COLLEGE DR STE 204
TEXARKANA TX
75503-3575
US

IV. Provider business mailing address

PO BOX 1326
MARSHALL TX
75671-1326
US

V. Phone/Fax

Practice location:
  • Phone: 903-791-1110
  • Fax:
Mailing address:
  • Phone: 903-927-3782
  • Fax: 903-927-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131307
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: