Provider Demographics
NPI:1306489281
Name:BRADLEY, LAWANA (MSN, APRN, APN-C)
Entity type:Individual
Prefix:
First Name:LAWANA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSN, APRN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72823-7165
Mailing Address - Country:US
Mailing Address - Phone:479-857-9229
Mailing Address - Fax:
Practice Address - Street 1:296 LAKE RD
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:AR
Practice Address - Zip Code:72823-7165
Practice Address - Country:US
Practice Address - Phone:479-857-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122366363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care