Individual
SHANNON RENEE BRADY-BARDSHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2220 W IOWA AVE, CHICKASHA, OK 73018-2738
(405) 779-2834
Mailing address
2220 W IOWA AVE, CHICKASHA, OK 73018-2738
(405) 779-2834
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
83612
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200452510A
—
OK
Enumeration date
03/03/2012
Last updated
10/09/2014
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