Leticia Bravo
Individual provider Active NPI Pediatrics Physician · Glasgow, KY
NPI 1164565180 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164565180
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 171002 (KY)
- Practice address
- 1411 N Race St
Glasgow, KY 42141-3474 - Phone
- (270) 651-9755
- Fax
- (270) 651-7562
- NPI assigned
- Feb 15, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 171002 | KY | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 171002 | KY | Yes |
Addresses
Primary practice location
1411 N Race St
Glasgow, KY 42141-3474
Mailing address
1411 N Race St
Glasgow, KY 42141-3474
Phone (270) 651-9755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64171002 | Medicaid | KY |
Other providers in Glasgow, KY
- William J Bradshaw
- Rachel Branham
- Gregory Branstetter
- Mary Lauretta Branstetter
- Regina Branum
- Orlando Bravo
- Amy Brickler
- Brightview LLC
- Annette Michelle Brooks
- Hazel Lynnette Brooks
All providers in Glasgow, KY · Pediatrics Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.