MEDICARE: MRS. IVANOLA BRADLEY NP

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	AP126847	TX

General Provider Information

NPI Number	:	1164825386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IVANOLA BRADLEY NP

Provider Business Mailing Address
First Line	:	6700 HOLLISTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-5331
Country	:	US
Telephone Number	:	713-718-9168
Fax Number	:	414-622-3836

Provider Business Practice Location Address
First Line	:	6700 HOLLISTER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-5331
Country	:	US
Telephone Number	:	713-718-9168
Fax Number	:	414-622-3836

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

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	10/10/2025

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