Individual
BRAD JAMES GAUTNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPNP-PC
Contact information
Practice address
1111 W AIRPORT FWY STE 143, IRVING, TX 75062-6204
(469) 488-4500
(469) 488-4501
Mailing address
1111 W AIRPORT FWY STE 143, IRVING, TX 75062-6204
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
672090
TX
363L00000X
Nurse Practitioner
AP145468
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
AP145468
TX
Other
Enumeration date
05/14/2020
Last updated
01/08/2026
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