Healthcare Provider Details

I. General information

NPI: 1619275153
Provider Name (Legal Business Name): BEVERLY SUE BRIDGES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 HIGHWAY 280 S
BIRMINGHAM AL
35242-5028
US

IV. Provider business mailing address

1 W LAKESHORE DR STE 100
BIRMINGHAM AL
35209-7271
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-4134
  • Fax: 205-408-1229
Mailing address:
  • Phone: 205-408-4134
  • Fax: 205-408-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-117729
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: