Jennifer Bradley

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN208474 Issued in GA

Practice address

1755 N Brown Rd Ste 200-1023
Lawrenceville, GA 30043-8198

Phone

(770) 281-0118

NPI assigned

Feb 12, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, AZ, TX3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Avant Behavioral Consultants IncGroup PAC ID 6709139975, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southern Regional Medical Center Hospital, Riverdale, GA, CCN 110165

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Carrington Clinic LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Lawrenceville, GA
  • NPI 1427734177

  AZ, Family

  Medicare reassignment NPD Authorized official
• Avant Behavioral Consultants Inc

  • Psychiatry Physician
  • Austell, GA
  • NPI 1598250342
  Medicare reassignment Care Compare group
• Southern Regional Physicians Management Group, LLC

  • Surgery Physician
  • Riverdale, GA
  • NPI 1043677271
  Medicare reassignment NPD
• Pool of Bethesda Psychiatric Health LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Surprise, AZ
  • NPI 1881240760
  Medicare reassignment NPD
• Clearminds Behavioral Health LLC

  • Psychiatry Physician
  • Palo Alto, CA
  • NPI 1437833753

  Psychiatric/Mental Health

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prime Healthcare Foundation - Southern Regional, LLC

  • General Acute Care Hospital
  • Riverdale, GA
  • NPI 1154795581
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1467811976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2636 ELM HILL PIKE",
            "address_2": "120",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372143162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 N BROWN RD STE 200-1023",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300438198",
            "telephone_number": "770-281-0118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3707 E Southern Ave # 523",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852062569",
            "country_code": "US",
            "telephone_number": "770-281-0118",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2636 Elm Hill Pike",
            "address_2": "120",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372143162",
            "country_code": "US",
            "telephone_number": "615-823-7622",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1333 W McDermott Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Allen",
            "state": "TX",
            "postal_code": "750133089",
            "country_code": "US",
            "telephone_number": "770-281-0118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-12",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN208474",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "283910",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN208474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Boykin
• Sandra Boyles, C.P. N. P.
• Madeleine Boyte, ATC
• Alana Meryll Bozeman, M.D.
• Christa McLendon Bracey
• Laduana Bradley, FNP-BC
• Tajuana B Bradley, FNP-C
• Tina F Bradley, R.N.
• Pia S. Bradshaw, M.S.
• Judith Brady, NURSE PRACTITIONER

• Psychiatric/Mental Health Nurse Practitioner in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.