Individual
BRADLEY KEITH SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
128 EARL CLARK DR, FLORENCE, MS 39073-6604
(601) 891-8465
(601) 891-8468
Mailing address
128 EARL CLARK DR, FLORENCE, MS 39073-6604
(601) 891-8465
(601) 891-8468
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
903096
MS
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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