Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71006859A | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71006859A | IN |
NPI | 1063950335 |
---|---|
Provider Name | Bradford Nathanial Whitehead |
First Address | Jeffersonville, IN 47130-4522 |
Second Address | Jeffersonville, IN 47130-4522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2017 |
Last Update Date | 07/02/2017 |