MEDICARE: MS. GLENDA ANNETTE BRADLEY APRN-BC

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	525236	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598774093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLENDA ANNETTE BRADLEY APRN-BC

Provider Business Mailing Address
First Line	:	1125 CYPRESS STATION DR
Second Line	:	STE B-1
City	:	HOUSTON
State	:	TX
Zip	:	77090-3054
Country	:	US
Telephone Number	:	281-586-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 CYPRESS STATION DR
Second Line	:	STE B-1
City	:	HOUSTON
State	:	TX
Zip	:	77090-3054
Country	:	US
Telephone Number	:	281-586-7880
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/24/2016

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