MEDICARE: ASHLEY BRADFORD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1195172	TX

General Provider Information

NPI Number	:	1114718418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BRADFORD FNP-C

Provider Business Mailing Address
First Line	:	3022 SOUTHLAND ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-4346
Country	:	US
Telephone Number	:	903-721-5186
Fax Number	:

Provider Business Practice Location Address
First Line	:	3022 SOUTHLAND ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-4346
Country	:	US
Telephone Number	:	903-721-5186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	06/23/2025

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Directions to “ ASHLEY BRADFORD FNP-C” Practice Location

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