Most Relevant Information
Provider Data
| NPI Number: | 1003178450 |
| Provider Name: | JASON DEREK BRADSHAW FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 687070 |
Most Important Dates
| Enumeration Date: | 06/12/2012 |
| Last Updated: | 06/12/2012 |
Provider Practice Location
1901 S 1ST ST
TEMPLE
TX
765047451
Practice Location Phone/Fax
| Phone: | 2547430714 |
| Fax: |
Provider Mailing Location
4006 FOUNTAINWOOD CIR
GEORGETOWN
TX
786331911
Provider Mailing Phone/Fax
| Phone: | 5126352759 |
| Fax: |