MEDICARE: BRIDGETT RENEE BRADLEY

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	251J00000X	Nursing Care Agency
2	385H00000X	Respite Care
3	253Z00000X	In Home Supportive Care Agency	I000000022060	TN

General Provider Information

NPI Number	:	1376040311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETT RENEE BRADLEY

Provider Business Mailing Address
First Line	:	PO BOX 343168
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38184-3168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1674 DELANO AVE UNIT 233
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-8515
Country	:	US
Telephone Number	:	901-318-6967
Fax Number	:	901-347-1259

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

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	05/15/2024

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Directions to “ BRIDGETT RENEE BRADLEY ” Practice Location

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