MEDICARE: MRS. DEBORAH M RADFORD RN, NPP, M.SC(A)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	533841	NY
2	363LF0000X	Family Nurse Practitioner	RN184531	AZ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F400881	NY
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5484	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295802957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH M RADFORD RN, NPP, M.SC(A)

Provider Business Mailing Address
First Line	:	3707 N STOCKTON HILL RD STE B
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-0507
Country	:	US
Telephone Number	:	928-757-8111
Fax Number	:	928-757-3256

Provider Business Practice Location Address
First Line	:	1741 SYCAMORE AVE
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409-0927
Country	:	US
Telephone Number	:	928-757-8111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	09/12/2022

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