Individual
JERRI BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
16370 US HIGHWAY 70, LONE GROVE, OK 73443-6535
(580) 224-2862
(580) 224-2863
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1402
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076780
—
OK
Enumeration date
07/16/2006
Last updated
03/13/2026
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