MRS. KELLI NICOLE BRIDGMAN (NPI# 1588841977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588841977 |
| Entity Type | Individual |
| Full Name | MRS. KELLI NICOLE BRIDGMAN |
| Credential | NP |
| Practice Address |
1637 Athens Hwy Grayson GA 30017-1768 |
| Mailing Address |
734 Ridgeland Rd Bethlehem GA 30620-2014 |
| Practice Telephone | 6783448268 |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2015-11-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN164274 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 448879182A | 05 |
| Street Address |
1637 ATHENS HWY |
| City | GRAYSON |
| State | GA |
| Zip Code | 30017-1768 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396263588 | Michael Thomas Bergquist | Counselor | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2017-09-07 |
| 1457802373 | Delia Harriet Williams | Counselor | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2016-10-14 |
| 1023483070 | Courtney Dombrowski | Counselor | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2015-12-02 |
| 1538461652 | Donna L. Cochran-harrow | Social Worker | 1637 Athens Hwy, Grayson, GA 30017-1768 | 2010-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588140859 | Butterfly Development, LLC | Community Based Residential Treatment Facility, Mental Illness | 1911 Grayson Highway, Suite 8-242, Grayson, GA 30017 | 2018-07-19 |
| 1811417132 | Yva Gauthier | Nurse Practitioner | 1620 Terry Mill Lane, Grayson, GA 30017 | 2017-06-27 |
| 1023341518 | Christine R Petro, Psy.d., LLC | Psychologist | 69 Grayson New Hope Rd, Grayson, GA 30017 | 2009-09-15 |
| 1902097579 | Zain Odeh Dabbas | Dentist | 2594 Loganviile Hwy, # 102, Grayson, GA 30017 | 2007-08-07 |
| 1619078276 | Primary Foot & Ankle Care | Podiatrist | 862 Amber Hill Ct, Grayson, GA 30017 | 2006-09-26 |
| 1700878170 | James Michael Long | Dentist | 2518 Loganville Hwy, Grayson, GA 30017 | 2005-08-22 |
| 1629556717 | Mason Moriah Earp | Physical Therapist | 2065 Grayson Hwy Ste B, Grayson, GA 30017 | 2018-08-01 |
| 1811482201 | Matthew Ntomoo Lo | Physical Therapy Assistant | 2065 Grayson Hwy Ste B, Grayson, GA 30017 | 2018-06-27 |
| 1144460668 | Alisa M Nelson-wade | Dentist | 2219 Loganville Hwy, Hwy 20, Grayson, GA 30017 | 2009-02-24 |
| 1003321662 | Grace Care Ambulance Transport, LLC | Ambulance | 516 Sosebee Farm Rd Unit 531, Grayson, GA 30017-0118 | 2017-12-05 |
| Find all providers in zip 30017 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154817815 | Ancy Bobby | Nurse Practitioner | 2530 Wevok Way, Grayson, GA 30017-4343 | 2018-07-06 |
| 1902328297 | Aritha Geraldine Francis | Nurse Practitioner | 710 Glenns Farm Way, Grayson, GA 30017-4927 | 2017-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154110 | Christina Danielle Palau Vaccari | Nurse Practitioner | 712 Pasley Ave Se, Atlanta, GA 30316-2158 | 2020-11-07 |
| 1427657113 | Cynthia Diane Prather | Nurse Practitioner | 3264 Lower Boston Rd, Thomasville, GA 31757-1311 | 2020-10-22 |
| 1932706728 | Alecia Ann Czarnecki | Nurse Practitioner | 6240 Crooked Creek Dr, Rex, GA 30273-5006 | 2020-10-05 |
| 1801401112 | Cotenna D. Clark | Nurse Practitioner | 1857 Cameo Ct, Tucker, GA 30084-7002 | 2020-09-14 |
| 1487264370 | Helen Young Yates | Nurse Practitioner | 40 Red Rock Ct Ne, Ludowici, GA 31316-6280 | 2020-08-05 |
| 1982214334 | Jasmine Alecia Henderson | Nurse Practitioner | 52 Roseberry Cir, Port Wentworth, GA 31407-5612 | 2020-07-31 |
| 1275142994 | Theresia Richardson | Nurse Practitioner | 2033 Buford Hwy Ste 109, Buford, GA 30518-8802 | 2020-07-28 |
| 1063021277 | Elsa Duncan Duncan | Nurse Practitioner | 1822 E Gwinnett St, Savannah, GA 31404-1853 | 2020-07-24 |
| 1154941946 | Joy P Wharton | Nurse Practitioner | 182 Silver Arrow Cir, Austell, GA 30168-7490 | 2020-04-21 |
| 1235769985 | Michelle Brack | Nurse Practitioner | 502 Hall Rd, Thomasville, GA 31757-8105 | 2020-01-22 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.