Provider Demographics
NPI:1912516154
Name:LITTLEFIELD, BRADAH (RN)
Entity Type:Individual
Prefix:
First Name:BRADAH
Middle Name:
Last Name:LITTLEFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31870 E. HWY 51
Mailing Address - Street 2:
Mailing Address - City:COWETA
Mailing Address - State:OK
Mailing Address - Zip Code:74426
Mailing Address - Country:US
Mailing Address - Phone:918-279-3200
Mailing Address - Fax:918-279-1118
Practice Address - Street 1:31870 E. HWY 51
Practice Address - Street 2:
Practice Address - City:COWETA
Practice Address - State:OK
Practice Address - Zip Code:74426
Practice Address - Country:US
Practice Address - Phone:918-279-3200
Practice Address - Fax:918-279-1118
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44583163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK445Medicaid