Provider Demographics
NPI:1831438472
Name:LEDFORD, CALEB R (ARNP)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:R
Last Name:LEDFORD
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SWIFT BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3513
Mailing Address - Country:US
Mailing Address - Phone:509-606-5040
Mailing Address - Fax:509-946-7253
Practice Address - Street 1:821 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3513
Practice Address - Country:US
Practice Address - Phone:509-606-5040
Practice Address - Fax:509-946-7253
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60330346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0448593OtherLABOR AND INDUSTRIES
WA2024673Medicaid
WA1831438472Medicaid