Provider Demographics
NPI:1477336584
Name:MCNEESE, BRADLEY CADE
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:CADE
Last Name:MCNEESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10629 S 91ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7044
Mailing Address - Country:US
Mailing Address - Phone:918-995-0652
Mailing Address - Fax:
Practice Address - Street 1:10629 S 91ST EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7044
Practice Address - Country:US
Practice Address - Phone:918-995-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program