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General NPI Number Information
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NPI Number | 1013723048
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Entity Type | Organization
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Legal Business Name | BEDROCK PSYCHIATRY
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 1405 N PIERCE ST STE 212
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5357
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Country | US
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Telephone | 501-725-0205
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Fax | 254-212-4442
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Provider Business Mailing Address
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Address Line | PO BOX 241248
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City | LITTLE ROCK
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State | AR
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Zip | 72223-0005
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Country | US
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Telephone | 501-725-0205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELSEY MCCLELLAN
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Credential | MD
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Telephone | 501-725-0205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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