Provider Demographics
NPI:1912692278
Name:BRAFFORD, HEATHER RAE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:BRAFFORD
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 1:103 W 7TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4219
Mailing Address - Country:US
Mailing Address - Phone:540-303-1834
Mailing Address - Fax:
Practice Address - Street 1:103 W 7TH ST APT 3
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4219
Practice Address - Country:US
Practice Address - Phone:540-303-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator