Provider Demographics
NPI:1033434527
Name:BRACY, KRISTEN TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:TAYLOR
Last Name:BRACY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 METAMORA RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9275
Mailing Address - Country:US
Mailing Address - Phone:858-414-2071
Mailing Address - Fax:
Practice Address - Street 1:9500 BAPTIST HEALTH DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6340
Practice Address - Country:US
Practice Address - Phone:501-224-5500
Practice Address - Fax:501-224-1166
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132951207V00000X
ARE-10127207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology