MEDICARE: BRIDGET CATHERINE O'LEARY PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1215567995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET CATHERINE O'LEARY PA-C

Provider Business Mailing Address
First Line	:	10719 CHESTNUT DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-2487
Country	:	US
Telephone Number	:	517-366-9826
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 MCNEIL ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3345
Country	:	US
Telephone Number	:	501-315-1222
Fax Number	:

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

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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Directions to “ BRIDGET CATHERINE O'LEARY PA-C” Practice Location

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