Healthcare Provider Details

I. General information

NPI: 1205332061
Provider Name (Legal Business Name): KELSEY BRADBURY KEITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY CATHERINE BRADBURY MD

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 615
LITTLE ROCK AR
72205-5308
US

IV. Provider business mailing address

500 S UNIVERSITY AVE STE 615
LITTLE ROCK AR
72205-5308
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4044
  • Fax: 501-664-4064
Mailing address:
  • Phone: 501-664-4044
  • Fax: 501-664-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-14361
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: