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General NPI Number Information
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NPI Number | 1639562432
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Entity Type | Organization
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Legal Business Name | BRADLEY BIBB MD PLLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 10144 HIGHWAY 63 N STE B
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City | BONO
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State | AR
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Zip | 72416
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Country | US
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Telephone | 870-520-6069
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Fax | 870-994-7488
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Provider Business Mailing Address
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Address Line | 4196 HIGHWAY 62 412 STE A
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City | HARDY
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State | AR
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Zip | 72542-8002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR CREDENTIALING
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Name | MONYA YORK
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Credential |
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Telephone | 870-856-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E 4136
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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