Active NPI
Eddie Ruth Bradford, FNP
- Family Nurse Practitioner
- Lula, MS
National Provider Identifier
1366599508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R659975
- Practice address
- 777 Isle of Capri Pkwy
Lula, MS 38644-9701 - Phone
- (662) 337-4554
- Fax
- (662) 337-4564
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R659975 | MS | Primary |
Addresses
Primary practice location
777 Isle of Capri Pkwy
Lula, MS 38644-9701
Mailing address
777 Isle of Capri Pkwy
Lula, MS 38644-9701
Phone (662) 337-4554
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 191427758 | Medicaid | AR | |
| 00119310 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Medical Equipment, LLC | Past | Accepting new patients | |
| Advanced Medical Rehabilitation, LLC | Family | Past | Accepting new patients |
| Webber Medical Complex | Past | Accepting new patients | |
| David Lee Webber D.O. P.a. | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Clarksdale, MS
- NPI 1750486049
-
- Internal Medicine Physician
- Helena, AR
- NPI 1205826575
-
- Family Medicine Physician
- Forrest City, AR
- NPI 1043202476
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567555200000",
"number": "1366599508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 ISLE OF CAPRI PKWY",
"city": "LULA",
"state": "MS",
"postal_code": "386449701",
"telephone_number": "662-337-4554",
"fax_number": "662-337-4564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 ISLE OF CAPRI PKWY",
"city": "LULA",
"state": "MS",
"postal_code": "386449701",
"telephone_number": "662-337-4554",
"fax_number": "662-337-4564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADFORD",
"first_name": "EDDIE",
"middle_name": "RUTH",
"name_prefix": "Ms.",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2019-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MS",
"license": "R659975",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "191427758",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00119310",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.