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General NPI Number Information
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NPI Number | 1568259182
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Entity Type | Individual
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Provider Name | CLAYTON JAMES BRADSHAW RN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 701 RAHLING RD APT 4312
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City | LITTLE ROCK
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State | AR
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Zip | 72223-3008
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Country | US
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Telephone | 501-733-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 701 RAHLING RD APT 4312
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City | LITTLE ROCK
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State | AR
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Zip | 72223-3008
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Country | US
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Telephone | 501-733-9120
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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 | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | 00
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 216407
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License Number State | AR
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