Provider Demographics
NPI:1114518438
Name:BRADDOCK, BETH (FNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BRADDOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15116 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9663
Mailing Address - Country:US
Mailing Address - Phone:740-804-2756
Mailing Address - Fax:
Practice Address - Street 1:15116 GIBSON RD
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9663
Practice Address - Country:US
Practice Address - Phone:740-804-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00035424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily