Healthcare Provider Details

I. General information

NPI: 1891608188
Provider Name (Legal Business Name): KOLE BRIDGES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA DRIVE NORTH MOBILE
MOBILE AL
36688-0001
US

IV. Provider business mailing address

119 VERDUN AVE
MOBILE AL
36606-4166
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-9334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: