1255633152 NPI number — KASHONDA BRADFORD

Table of content: DR. JANA KOKKONEN REED MD (NPI 1487602108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255633152 NPI number — KASHONDA BRADFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KASHONDA BRADFORD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255633152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2362
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47131-2362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-581-8556
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19263 SANDELFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77449-4150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-581-8556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRADFORD
Authorized Official First Name:
KASHONDA
Authorized Official Middle Name:
JUANITA
Authorized Official Title or Position:
LVN
Authorized Official Telephone Number:
832-581-8556

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)