Provider Demographics
NPI:1851024277
Name:BRADFORD, KAY CHARMAIN WAUGH
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:CHARMAIN WAUGH
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5748
Mailing Address - Country:US
Mailing Address - Phone:956-802-2443
Mailing Address - Fax:956-968-5077
Practice Address - Street 1:1203 W 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5748
Practice Address - Country:US
Practice Address - Phone:956-802-2443
Practice Address - Fax:956-968-5077
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2021185011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health