1427024793 NPI number — JULIETTE CARRINGTON BRIDGEMAN WHNP

Table of content: KANESHA LASHUN MCCLELLAN (NPI 1134782261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427024793 NPI number — JULIETTE CARRINGTON BRIDGEMAN WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDGEMAN
Provider First Name:
JULIETTE
Provider Middle Name:
CARRINGTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427024793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLANCHFIELD ARMY COMMUNITY HOSPITAL
Provider Second Line Business Mailing Address:
650 JOEL DR.
Provider Business Mailing Address City Name:
FT. CAMPBELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42223-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-798-8372
Provider Business Mailing Address Fax Number:
270-956-0180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLANCHFIELD ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
650 JOEL DR.
Provider Business Practice Location Address City Name:
FT. CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223-5349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-798-8372
Provider Business Practice Location Address Fax Number:
270-956-0180
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  0024166602 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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