Provider Demographics
NPI:1326468059
Name:BRADBURY, SAVANNAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 ADA AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4985
Mailing Address - Country:US
Mailing Address - Phone:501-932-0352
Mailing Address - Fax:501-932-0354
Practice Address - Street 1:2200 ADA AVE STE 302
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4985
Practice Address - Country:US
Practice Address - Phone:501-932-0352
Practice Address - Fax:501-932-0354
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T1422363AM0700X
ARPA-560363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical