LISA BRADHAM (NPI# 1568766145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568766145 |
| Entity Type | Individual |
| Full Name | LISA BRADHAM |
| Credential | CFNP |
| Practice Address |
401 S Church St Charleston MS 38921-2257 |
| Practice Telephone | 6626475816 |
| Practice Fax Number | 6626475705 |
| Mailing Telephone | 6626475816 |
| Mailing Fax Number | 6626475705 |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2013-02-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R865030 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09822395 | 05 |
| Street Address |
401 S CHURCH ST |
| City | CHARLESTON |
| State | MS |
| Zip Code | 38921-2257 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477644466 | Yolanda K Berkley | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2006-09-27 |
| 1013559426 | Jessica Elizabeth Mcgee | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2019-10-17 |
| 1447891692 | Audrey Leann Williamson | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2019-09-30 |
| 1679124713 | Catherine Moring | Dietitian, Registered | 401 S Church St, Charleston, MS 38921-2257 | 2019-09-20 |
| 1417425620 | Raedena L Hill | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2018-11-06 |
| 1134596919 | Cassala Ward | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2015-08-27 |
| 1801287883 | Shana Belle Smith | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2015-02-11 |
| 1457796922 | Monica Joy Carter | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2013-05-09 |
| 1831329887 | Charleston Clinic | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2009-07-23 |
| 1649477191 | Robert L. Carter | Emergency Medicine | 401 S Church St, Charleston, MS 38921-2257 | 2007-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538717459 | Square Drugs, LLC | Pharmacy | 126 Court Square, Charleston, MS 38921 | 2019-09-04 |
| 1588015341 | Kyle Wiggins | Dentist | 203 South Market St, Charleston, MS 38921 | 2016-06-23 |
| 1659555761 | Tallahatchie General Hospital and Extended Care Facility | Nursing Facility/Intermediate Care Facility | 201 South Market Street, Charleston, MS 38921 | 2007-12-26 |
| 1316152010 | Wolfe Family Medical Clinic Pllc | Clinic/Center | 203 E Walnut St, Charleston, MS 38921 | 2007-05-14 |
| 1962617530 | East Tallahatchie Schools | Registered Nurse | 35 Oak Grove Road, Charleston, MS 38921 | 2007-05-14 |
| 1518052661 | Carlene Maynor Wolfe | Nurse Practitioner | 204 East Walnut Street, Charleston, MS 38921 | 2006-10-04 |
| 1003921172 | James Oscar Wilde Jr. | Family Medicine | 201 S. Market St., Charleston, MS 38921 | 2006-08-20 |
| 1851919658 | Delta Med South, Inc. | Durable Medical Equipment & Medical Supplies | 7 Court Sq, Charleston, MS 38921 | 2020-07-08 |
| 1932616950 | Sharon Bradley | Homemaker | 29 Nell St, Charleston, MS 38921-1424 | 2017-12-30 |
| 1649595505 | Lasuna M Curry | Counselor | 17 N Market St, Charleston, MS 38921-1524 | 2010-04-05 |
| Find all providers in zip 38921 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417557737 | Diondra Johnson | Nurse Practitioner | 2327 Watchtower Ln, Charleston, SC 29414-7803 | 2020-10-27 |
| 1427656735 | Kisha Lanece James | Nurse Practitioner | 16 Red Mulberry Way Apt 3, Charleston, WV 25306-0107 | 2020-10-09 |
| 1043822216 | Amber Bagwell | Nurse Practitioner | 442 King St Fl 2, Charleston, SC 29403-6230 | 2020-08-19 |
| 1790396273 | Amanda Jo Grant | Nurse Practitioner | 2207 Seneca Dr, Charleston, IL 61920-3836 | 2020-08-10 |
| 1811514961 | Isabel Margarita Lemasters | Nurse Practitioner | 3226 Moonlight Dr, Charleston, SC 29414-8052 | 2020-07-05 |
| 1255954566 | Christina L. White | Nurse Practitioner | 1199 Persimmon Rd, Charleston, IL 61920 | 2020-05-20 |
| 1770123929 | Catherine A. Woods | Nurse Practitioner | 9313 Medical Plaza Dr Ste 310, Charleston, SC 29406-9197 | 2020-01-15 |
| 1104464999 | Brittany D Griffith | Nurse Practitioner | 830 Pennsylvania Ave Ste 402, Charleston, WV 25302-3390 | 2019-12-12 |
| 1437795747 | Brigitte Britt Huttemeyer | Nurse Practitioner | 678 Castle Pinckney Dr, Charleston, SC 29412 | 2019-11-21 |
| 1124660774 | Dennis Robert Moore | Nurse Practitioner | 4610 Kanawha Ave Sw Ste 302, Charleston, WV 25309-1367 | 2019-10-16 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 38921 |
Please comment or provide details below to improve the information on LISA BRADHAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.