Individual
CHARLES BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 977-4440
(314) 977-3370
Mailing address
1008 S SPRING AVE FL 2, SAINT LOUIS, MO 63110-2520
(314) 977-8462
(314) 977-3370
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018033937
MO
363LF0000X
Family Nurse Practitioner
209.018613
IL
363LG0600X
Gerontology Nurse Practitioner
2017037322
MO
Other
Enumeration date
02/11/2019
Last updated
03/12/2021
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