MEDICARE: MISS BRIDGET ANN ESPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164787867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRIDGET ANN ESPY

Provider Business Mailing Address
First Line	:	2801 S VALLEY VIEW BLVD STE 11
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0176
Country	:	US
Telephone Number	:	702-629-5815
Fax Number	:	702-629-5815

Provider Business Practice Location Address
First Line	:	1200 W CHEYENNE AVE APT 1025
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7830
Country	:	US
Telephone Number	:	702-917-2227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	11/20/2018

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Directions to “ MISS BRIDGET ANN ESPY ” Practice Location

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