Individual
ANNE MARIE BRIDEGROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
261 DUNN RD, FLORISSANT, MO 63031-7928
(314) 830-2600
(314) 830-2648
Mailing address
PO BOX 650, EDWARDSVILLE, IL 62025-0650
(314) 830-2600
(314) 830-2648
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085009102
IL
363AM0700X
Medical Physician Assistant
Primary
2021004987
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1392PA
—
SC
Enumeration date
03/13/2012
Last updated
02/09/2026
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