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General NPI Number Information
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NPI Number | 1356153506
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Entity Type | Individual
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Provider Name | JENNIFER DAWN BRADFORD APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 230 GEORGE ST STE 2
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City | BECKLEY
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State | WV
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Zip | 25801-2620
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Country | US
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Telephone | 304-255-2878
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81
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City | FAIRDALE
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State | WV
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Zip | 25839-0081
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Country | US
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Telephone | 304-890-7806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 121948
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License Number State | WV
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