Healthcare Provider Details

I. General information

NPI: 1972805133
Provider Name (Legal Business Name): BRIDGET RANDOLPH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 HIGHWAY 54 W STE 2200
FAYETTEVILLE GA
30214-2110
US

IV. Provider business mailing address

PO BOX 30589
MIDWEST CITY OK
73140-3589
US

V. Phone/Fax

Practice location:
  • Phone: 770-716-0051
  • Fax:
Mailing address:
  • Phone: 405-769-3301
  • Fax: 405-769-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN230003
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN230003
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83618
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: