Individual
JESSICA BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
212 MAIN ST, MINNEOLA, KS 67865-8511
(620) 255-2917
Mailing address
1006 N WHITFIELD ST, WICHITA, KS 67206-1352
(620) 255-2917
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15-02666
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/10/2022
Last updated
12/30/2022
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