Provider Demographics
NPI:1568259182
Name:BRADSHAW, CLAYTON JAMES (RN)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JAMES
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 RAHLING RD APT 4312
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3008
Mailing Address - Country:US
Mailing Address - Phone:501-733-9120
Mailing Address - Fax:
Practice Address - Street 1:701 RAHLING RD APT 4312
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3008
Practice Address - Country:US
Practice Address - Phone:501-733-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00363LS0200X
AR216407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool