Healthcare Provider Details

I. General information

NPI: 1043157902
Provider Name (Legal Business Name): JOHN BRADFORD PATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4868 NE 1174TH AVE
RED OAK OK
74563-5023
US

IV. Provider business mailing address

4868 NE 1174TH AVE
RED OAK OK
74563-5023
US

V. Phone/Fax

Practice location:
  • Phone: 918-471-8611
  • Fax:
Mailing address:
  • Phone: 918-471-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206293
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: