Individual
MRS. REATHA JEANNETTE BRADBERRY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3838 W PARK AVE, ORANGE, TX 77630-1812
(409) 886-8700
(409) 886-5305
Mailing address
3838 W PARK AVE, ORANGE, TX 77630-1812
(409) 886-8700
(409) 886-5305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
561891
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161031301
—
TX
01
—
760357897
WORKERS COMPENSATION
TX
Enumeration date
05/05/2006
Last updated
12/31/2008
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