1164446274 NPI number — BRIDGETT L CUNNINGHAM BCFNP

Table of content: BRIDGETT L CUNNINGHAM BCFNP (NPI 1164446274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164446274 NPI number — BRIDGETT L CUNNINGHAM BCFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
BRIDGETT
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCFNP
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:
1164446274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88
Provider Second Line Business Mailing Address:
5 E ALVON ROAD SUITE 7
Provider Business Mailing Address City Name:
WHITE SULPHUR SPRINGS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24986-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-536-5030
Provider Business Mailing Address Fax Number:
304-536-5031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25702-1241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-399-7484
Provider Business Practice Location Address Fax Number:
304-399-7484
Provider Enumeration Date:
07/26/2006

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: 363LF0000X , with the licence number:  56008 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2851605 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100066230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7104198000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1062972 . This is a "BRICK STREET (WV COMP)" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1164446274 . This is a "MTN BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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