Individual
BRADEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN-CNP
Contact information
Practice address
217 N HARRISON AVE STE 109, BLANCHARD, OK 73010-6217
(405) 888-8483
(918) 803-4861
Mailing address
217 N HARRISON AVE STE 109, BLANCHARD, OK 73010-6217
(405) 888-8483
(918) 803-4861
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
90405
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200701320A
—
OK
Enumeration date
03/30/2017
Last updated
03/06/2026
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