Provider Demographics
NPI:1679584635
Name:BRADLEY, SANDRA KAY (RNC, BSN, NNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RNC, BSN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 ROCK PRAIRIE RD
Mailing Address - Street 2:COLLEGE STATION MEDICAL CENTER-NICU
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8395
Mailing Address - Country:US
Mailing Address - Phone:979-764-5115
Mailing Address - Fax:979-764-5268
Practice Address - Street 1:1604 ROCK PRAIRIE RD
Practice Address - Street 2:COLLEGE STATION MEDICAL CENTER-NICU
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8395
Practice Address - Country:US
Practice Address - Phone:979-764-5115
Practice Address - Fax:979-764-5268
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544245363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX96185602Medicaid
TX83N359Medicare ID - Type UnspecifiedWHILE EMPLOYED AT UTSCSA