# REATHA S BRADBERRY FNP-C LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811137078
- **Authorized official:** MRS. REATHA S BRADBERRY FNP-C (NURSE PRACTITIONER)
- **Authorized official phone:** (409) 886-8700

## Contact information

- **Practice address:** 3838 W PARK AVE, ORANGE, TX 77630-1812
- **Practice address phone:** (409) 886-8700
- **Practice address fax:** (409) 886-5305
- **Mailing address:** 3838 W PARK AVE, ORANGE, TX 77630-1812
- **Mailing address phone:** (409) 886-8700
- **Mailing address fax:** (409) 886-5305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 561891 | TX | Yes |

## Other

- **Enumeration date:** 03/01/2009
- **Last updated:** 03/01/2009