Tricia Bradford
Individual provider Active NPI Audiologist · Jackson, MS
NPI 1629252010 · NPPES record last updated Dec 21, 2007
Key facts
- NPI
- 1629252010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- AO661 (MS)
- Practice address
- 1253 Eastover Dr
Jackson, MS 39211-6315 - Phone
- (601) 984-8036
- Fax
- (601) 984-8030
- NPI assigned
- Dec 21, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AO661 | MS | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ms School for the Deaf and Blind | Audiologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | AO661 | MS | Yes |
Addresses
Primary practice location
1253 Eastover Dr
Jackson, MS 39211-6315
Mailing address
1253 Eastover Dr
Jackson, MS 39211-6315
Phone (601) 984-8036
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00076026 | Medicaid | MS |
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.