Provider Demographics
NPI:1316336399
Name:BRADFORD, RACHELLE LADAWN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LADAWN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 C TREE RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-9002
Mailing Address - Country:US
Mailing Address - Phone:918-420-6495
Mailing Address - Fax:918-420-7497
Practice Address - Street 1:1 C TREE RD BLDG 5
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-9002
Practice Address - Country:US
Practice Address - Phone:918-420-6495
Practice Address - Fax:918-420-7497
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0090411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily