Healthcare Provider Details

I. General information

NPI: 1831906593
Provider Name (Legal Business Name): BRADLEY BIBB MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 E WABASH ST
FRANKFORT IN
46041-9429
US

IV. Provider business mailing address

4196 HIGHWAY 62 412 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 765-357-3800
  • Fax: 765-357-3813
Mailing address:
  • Phone: 870-856-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONYA YORK
Title or Position: DIRECTOR CREDENTIALING
Credential:
Phone: 870-856-1202