Provider Demographics
NPI:1922632157
Name:STRADFORD, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:STRADFORD
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 1:1340 COUNTY POND RD
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:VA
Mailing Address - Zip Code:23856-2604
Mailing Address - Country:US
Mailing Address - Phone:434-532-6770
Mailing Address - Fax:
Practice Address - Street 1:1340 COUNTY POND RD
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:VA
Practice Address - Zip Code:23856-2604
Practice Address - Country:US
Practice Address - Phone:434-532-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69531964372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion