Basic Information
| Provider Information | |||||||||
| NPI: | 1427515915 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | BRADLEY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CLIFTON | ||||||||
| OtherFirstName: | BRAD | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | APRN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2106 LOOP RD | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712953344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184125265 | ||||||||
| FaxNumber: | 3184353842 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 VERONA STREET | ||||||||
| Address2: | |||||||||
| City: | NEWELLTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184679949 | ||||||||
| FaxNumber: | 3184672093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2019 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 203909 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.