=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083411722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDNORA BRADLEY MASON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2025
-----------------------------------------------------
Last Update Date | 11/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6147 JEFFERSON AVE
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23605-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-826-1300
-----------------------------------------------------
Fax | 804-482-3761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 PEACH TREE CRES
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23602-7494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-342-5461
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 0024194101
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0024194101
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------