Provider Demographics
NPI:1417645284
Name:SLOAN, WILLIAM BRADLEY (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:SLOAN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-5426
Mailing Address - Country:US
Mailing Address - Phone:662-322-2620
Mailing Address - Fax:
Practice Address - Street 1:1415 UNIVERSITY AVE STE I
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4031
Practice Address - Country:US
Practice Address - Phone:662-801-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905961207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine