Basic Information
| Provider Information | |||||||||
| NPI: | 1891884649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VESSEL | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1939 | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | LIVINGSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773510037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139608008 | ||||||||
| FaxNumber: | 7139600965 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 POST OAK PLACE DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770273164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139608008 | ||||||||
| FaxNumber: | 7139600965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP119552 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 102750 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 693051 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.