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General NPI Number Information
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NPI Number | 1538309489
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Entity Type | Organization
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Legal Business Name | CSD MEDICAL SERVICES
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 18 VILLAGE PLZ
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1745
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Country | US
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Telephone | 859-227-4835
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Fax | 502-453-0790
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Provider Business Mailing Address
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Address Line | 18 VILLAGE PLZ
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1745
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Country | US
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Telephone | 859-227-4835
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Fax | 502-453-0790
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | SHELLEY D. BRADLEY
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Credential | ARNP, RNFA
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Telephone | 859-227-4835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4229P
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License Number State | KY
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