Individual
MISS BRIDGET RANDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1267 HIGHWAY 54 W STE 2200, FAYETTEVILLE, GA 30214-2110
(770) 716-0051
Mailing address
PO BOX 30589, MIDWEST CITY, OK 73140-3589
(405) 769-3301
(405) 769-9685
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN230003
GA
363LF0000X
Family Nurse Practitioner
83618
OK
363LF0000X
Family Nurse Practitioner
RN230003
GA
Other
Enumeration date
11/21/2010
Last updated
10/18/2021
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