Provider Demographics
NPI:1932707346
Name:PATTERSON, BRADLEY WAYNE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WAYNE
Last Name:PATTERSON
Suffix:
Gender:M
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 740
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-0740
Mailing Address - Country:US
Mailing Address - Phone:870-584-3000
Mailing Address - Fax:870-584-3003
Practice Address - Street 1:1553 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3801
Practice Address - Country:US
Practice Address - Phone:870-584-3000
Practice Address - Fax:870-584-3003
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213247363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner