Individual
MRS. BRIDGETTE RUNNELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1 LINCOLN PKWY STE 300, HATTIESBURG, MS 39402-3261
(601) 296-2870
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5430
(601) 579-5431
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
893522
MS
363LF0000X
Family Nurse Practitioner
Primary
893522
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00771500
—
MS
Enumeration date
01/08/2015
Last updated
07/19/2021
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