Individual
MR. JACOB BRADLEY KEITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
500 W THOMAS RD STE 500, PHOENIX, AZ 85013-4220
(602) 406-4000
(602) 406-6498
Mailing address
500 W THOMAS RD STE 500, PHOENIX, AZ 85013-4220
(602) 406-4000
(602) 406-6498
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
306974
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200810
—
AZ
Enumeration date
08/18/2021
Last updated
02/27/2026
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