Bradley, William

Bradley, William is an sole proprietor health care provider with primary practice located at 200 Southland Dr , Sikeston MO 63801-4403. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Bradley, William can be contacted via phone (573) 427-1770.

Contact Information

Primary practice address
200 Southland Dr Sikeston MO 63801-4403
Fax: (573) 472-4050
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 131573 Missouri

Profile Details

NPI number 1649375940
LBN Legal business name Bradley, William
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 13th, 2006
Last updated Jun 8th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649375940 NPPES
Missouri MEDICAID 427752506

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