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General NPI Number Information
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NPI Number | 1518064583
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Entity Type | Individual
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Provider Name | BASCOM KYLE BRADSHAW D.O., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2191 E JOHNSON AVE
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City | PENSACOLA
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State | FL
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Zip | 32514-6029
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Country | US
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Telephone | 850-494-3917
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Fax | 850-494-3960
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Provider Business Mailing Address
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Address Line | PO BOX 409075
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City | ATLANTA
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State | GA
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Zip | 30384-9075
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Country | US
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Telephone | 615-373-7600
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Fax | 866-347-1426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number | 02002502A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO.1388
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 02002502A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 73929
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | OS16451
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2018-01630
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License Number State | NC
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