Provider Demographics
NPI:1205332061
Name:KEITH, KELSEY BRADBURY (MD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:BRADBURY
Last Name:KEITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:CATHERINE
Other - Last Name:BRADBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5308
Mailing Address - Country:US
Mailing Address - Phone:501-664-4044
Mailing Address - Fax:501-664-4064
Practice Address - Street 1:500 S UNIVERSITY AVE STE 615
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5308
Practice Address - Country:US
Practice Address - Phone:501-664-4044
Practice Address - Fax:501-664-4064
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-14361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR272153001Medicaid