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Individual
KELLY A BRIDGES
Active
Individual
KELLY A BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
22978
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229782
—
SC
01
—
H595876162
MEDICARE PIN
SC
01
—
P00691795
RR MEDICARE
SC
Enumeration date
05/18/2006
Last updated
12/02/2020
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