Provider Demographics
NPI:1780823450
Name:LEDBETTER, TINA SPRADLEY (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:SPRADLEY
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W THOMASON CIR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5436
Mailing Address - Country:US
Mailing Address - Phone:334-745-7579
Mailing Address - Fax:334-749-3530
Practice Address - Street 1:516 W THOMASON CIR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5436
Practice Address - Country:US
Practice Address - Phone:334-745-7579
Practice Address - Fax:334-749-3530
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse