Provider Demographics
NPI:1356153506
Name:BRADFORD, JENNIFER DAWN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25839-0081
Mailing Address - Country:US
Mailing Address - Phone:304-890-7806
Mailing Address - Fax:
Practice Address - Street 1:230 GEORGE ST STE 2
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2620
Practice Address - Country:US
Practice Address - Phone:304-255-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV121948363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care