Individual
MS. EDDIE RUTH BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
777 ISLE OF CAPRI PKWY, LULA, MS 38644-9701
(662) 337-4554
(662) 337-4564
Mailing address
777 ISLE OF CAPRI PKWY, LULA, MS 38644-9701
(662) 337-4554
(662) 337-4564
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R659975
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119310
—
MS
05
—
191427758
—
AR
Enumeration date
01/03/2007
Last updated
09/04/2019
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