Whitney Jo Bradford, APRN
Individual provider Active NPI Family Nurse Practitioner · Kennett, MO
NPI 1346736873 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1346736873
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2018042028 (MO)
- Practice address
- 900 State Route VV
Kennett, MO 63857-3834 - Phone
- (573) 559-2365
- NPI assigned
- Jul 9, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- FCC Medical Clinics LLC
Practice addresses (Care Compare)
900 State Route VV
Kennett, MO 63857-3834
Phone (573) 559-2365
Hospital & facility affiliations
- Visiting Nurse Association of Southeast Missouri, Inc
- Arkansas Methodist Medical Center
- Poplar Bluff Regional Medical Center
- Piggott Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190625000653 | MO | Practitioner - Nurse Practitioner | 7315296449 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center, Inc. | Current |
Accepting new patients | |
| FCC Medical Clinics LLC | Current |
Accepting new patients | |
| Family Counseling Center, Inc. | Current |
Accepting new patients | |
| Family Counseling Center, Inc. | Past | Accepting new patients |
Locations
925 State Route VV
Kennett, MO 63857
Phone (573) 359-9840
900 State Route VV
Kennett, MO 63857
Phone (573) 559-2365
3001 Warrior Ln
Poplar Bluff, MO 63901
Phone (573) 785-7453
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | A005717 | AR | |
| Primary Care Nurse Practitioner | 363LP2300X | A005717 | AR | |
| Family Nurse Practitioner | 363LF0000X | 2018042028 | MO | Yes |
Addresses
Primary practice location
900 State Route VV
Kennett, MO 63857-3834
Mailing address
900 State Route VV
Kennett, MO 63857-3834
Phone (573) 559-2365
Other providers in Kennett, MO
- Christopher Michael Bowen
- Heather Bowman
- Tracy Marie Bowman
- Cynthia Kay Boyd
- Erica Lynn Boyet
- Brian Branum
- Marsha J Branum
- Teresa Brasher
- Dione A Breakfield
- Joleen Brege
All providers in Kennett, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.