Healthcare Provider Details

I. General information

NPI: 1013724764
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: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S 1ST ST
CHICKASHA OK
73018-6007
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 405-320-9444
  • Fax: 405-320-9666
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