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NPI Code Detail

MEDICARE: SHAWN BRIDWELL PA

MEDICARE: SHAWN BRIDWELL PA
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
1363A00000XPhysician Assistant913OK

General Provider Information

NPI Number : 1932187382
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN BRIDWELL PA
Provider Business Mailing Address
First Line : 1438 HARDCASTLE BLVD
Second Line :
City : PURCELL
State : OK
Zip : 73080-8233
Country : US
Telephone Number : 405-527-4700
Fax Number : 405-527-4903
Provider Business Practice Location Address
First Line : 1438 HARDCASTLE BLVD
Second Line :
City : PURCELL
State : OK
Zip : 73080-8233
Country : US
Telephone Number : 405-527-4700
Fax Number : 405-527-4903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 10/22/2025

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Directions to “ SHAWN BRIDWELL PA” Practice Location

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