Individual
GENNA BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1803 S WOOD DR, OKMULGEE, OK 74447-6825
(918) 758-4110
Mailing address
108 N SHERMAN AVE, OKMULGEE, OK 74447-2817
(256) 702-2045
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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