Organization
CSD MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY D. BRADLEY ARNP, RNFA (OWNER, PROVIDER)
(859) 227-4835
Entity
Organization
Contact information
Practice address
18 VILLAGE PLZ, SHELBYVILLE, KY 40065-1745
(859) 227-4835
(502) 453-0790
Mailing address
18 VILLAGE PLZ, SHELBYVILLE, KY 40065-1745
(859) 227-4835
(502) 453-0790
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4229P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000562862
ANTHEM BCBS
KY
05
—
78014354
—
KY
Enumeration date
03/04/2009
Last updated
03/04/2009
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