Individual
BRADLEY COKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1850 CHADWICK DR, JACKSON, MS 39204-3404
(601) 376-1848
(601) 376-1894
Mailing address
PO BOX 7539, JACKSON, MS 39284-7539
(601) 376-1848
(601) 376-1894
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R877301
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00304891
—
MS
Enumeration date
01/03/2012
Last updated
07/06/2016
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