Provider Demographics
NPI:1588197362
Name:BRADLEY, KARLI CITTY (PA)
Entity Type:Individual
Prefix:MRS
First Name:KARLI
Middle Name:CITTY
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KARLI
Other - Middle Name:CITTY
Other - Last Name:BLICKENSTAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 SHACKLEFORD WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3886
Mailing Address - Country:US
Mailing Address - Phone:501-664-5860
Mailing Address - Fax:
Practice Address - Street 1:7 SHACKLEFORD WEST BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3886
Practice Address - Country:US
Practice Address - Phone:501-664-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-703363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant