Provider Demographics
NPI:1164856993
Name:BRADFORD, COLLEEN ANN (PNP)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PNP
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Mailing Address - Street 1:456 N NEW BALLAS RD
Mailing Address - Street 2:STE 304
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6831
Mailing Address - Country:US
Mailing Address - Phone:314-567-6868
Mailing Address - Fax:314-567-0578
Practice Address - Street 1:456 N NEW BALLAS RD
Practice Address - Street 2:STE 304
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6831
Practice Address - Country:US
Practice Address - Phone:314-567-6868
Practice Address - Fax:314-567-0578
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2024-01-12
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Provider Licenses
StateLicense IDTaxonomies
MO2017036482363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics