MEDICARE: SIDNEY WORRELL BRADLEY 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	363L00000X	Nurse Practitioner	5020133	NC

General Provider Information

NPI Number	:	1124868070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDNEY WORRELL BRADLEY FNP-C

Provider Business Mailing Address
First Line	:	2695 L T HARDEE RD # A
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-7703
Country	:	US
Telephone Number	:	919-922-5845
Fax Number	:

Provider Business Practice Location Address
First Line	:	3106 ARENDELL ST
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3202
Country	:	US
Telephone Number	:	252-808-2500
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/30/2024

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