MEDICARE: NIKKI 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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1992325328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI BRADLEY

Provider Business Mailing Address
First Line	:	17424 W GRAND PKWY S # 316
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2564
Country	:	US
Telephone Number	:	832-725-1507
Fax Number	:

Provider Business Practice Location Address
First Line	:	7902 LAKE COMMERCE DRIVE
Second Line	:
City	:	ROSENBERG
State	:	TX
Zip	:	77469
Country	:	US
Telephone Number	:	832-725-1507
Fax Number	:

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

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	04/27/2020

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Directions to “ NIKKI BRADLEY ” Practice Location

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