Provider Demographics
NPI:1235154642
Name:BRADFORD, KAREN RAE (CNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:RAE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248804
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8804
Mailing Address - Country:US
Mailing Address - Phone:405-749-2111
Mailing Address - Fax:405-749-2113
Practice Address - Street 1:9225 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4453
Practice Address - Country:US
Practice Address - Phone:405-749-2111
Practice Address - Fax:405-749-2113
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0028041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily