Individual
BRAD N JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2508 CRESTWOOD LANE, NORTH LITTLE ROCK, AR 72116-7623
(501) 758-2294
(501) 758-7887
Mailing address
11001 EXECUTIVE CENTER DRIVE, SUITE 200, LITTLE ROCK, AR 72211-4393
(501) 812-7800
(501) 812-7777
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E-2046
AR
207P00000X
Emergency Medicine Physician
E2046
AR
207Q00000X
Family Medicine Physician
Primary
E-2046
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136241001
—
AR
01
—
19145000040
QUALCHOICE
AR
01
—
435276
HEALTHLINK
AR
01
—
7824049
AETNA
AR
Enumeration date
08/30/2006
Last updated
11/19/2014
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