MEDICARE: HALEY NICOLE BRADSHAW

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	35051	TN

General Provider Information

NPI Number	:	1558134908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY NICOLE BRADSHAW

Provider Business Mailing Address
First Line	:	206 CEDAR LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3507
Country	:	US
Telephone Number	:	865-666-3640
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 CEDAR LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-3507
Country	:	US
Telephone Number	:	865-666-3640
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	07/10/2025

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Directions to “ HALEY NICOLE BRADSHAW ” Practice Location

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