Dr. Bascom Kyle Bradshaw, D.O., M.P.H.
Psychiatry & Neurology, Psychiatry in Pensacola, FL. Individual provider (NPI-1).
NPI number1518064583
StatusActive
Last updated in NPPESApr 16, 2025
Details
- NPI
- 1518064583
- Entity type
- Individual (NPI-1)
- Name
- Dr. Bascom Kyle Bradshaw
- Credential
- D.O., M.P.H.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 20, 2006
- Certification date
- Apr 16, 2025
- Last updated
- Apr 16, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | 2018-01630 | NC | Yes |
| 2083A0100X | Preventive Medicine, Aerospace Medicine | 02002502A | IN | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | DO.1388 | AL | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | 02002502A | IN | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | 73929 | GA | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | OS16451 | FL |
Practice location
2191 E Johnson AvePensacola, FL 32514-6029
Phone 850-494-3917 · Fax 850-494-3960
Mailing address
Po Box 409075Atlanta, GA 30384-9075
Phone 615-373-7600 · Fax 866-347-1426
Other practice locations
1225 Ne 2nd Ave
Portland, OR 97232-2003
Portland, OR 97232-2003
Phone 503-944-8000
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