Healthcare Provider Details

I. General information

NPI: 1578441432
Provider Name (Legal Business Name): BRADLEY I SEXTON LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 OWL CREEK CUTOFF
ROYAL AR
71968-9414
US

IV. Provider business mailing address

531 OWL CREEK CUTOFF
ROYAL AR
71968-9414
US

V. Phone/Fax

Practice location:
  • Phone: 501-762-3697
  • Fax:
Mailing address:
  • Phone: 501-762-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL059616
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: