| NPI | 1194441402 |
|---|---|
| Former Name | JEANA BRADFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3018548) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WV 115560) |
| 363LF0000X Nurse Practitioner Family (Licence: KY 3018548) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WV 115560) | |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2023-08-23 |