1427625128 NPI number — DR. VIRGINIA FAYE BRADLEY DNP PMHNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427625128 NPI number — DR. VIRGINIA FAYE BRADLEY DNP PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADLEY
Provider First Name:
VIRGINIA
Provider Middle Name:
FAYE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427625128
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 LYNWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24605-8980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-214-8660
Provider Business Mailing Address Fax Number:
304-313-4559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 LYNWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24605-8980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-214-8660
Provider Business Practice Location Address Fax Number:
276-242-3555
Provider Enumeration Date:
06/10/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  95342351 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 1315620 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 214605 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 118038 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 95028544 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 31140 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 25177A , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 0024184968 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31140 . This is a "TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH RELATED BOARDS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5014536 . This is a "NORTH CAROLINA BOARD OF NURSING" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0024184968 . This is a "COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001315620 . This is a "VIRGINIA BOARD OF NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 95028544 . This is a "STATE OF CALIFORNIA BOARD OF REGISTERED NURSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 118038 . This is a "THE WEST VIRGINIA BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 95028544 . This is a "BOARD OF NURSING" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 95028544 . This is a "NURES PRACTITIONER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 25177A . This is a "SOUTH CAROLINA BOARD OF NURSING" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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