Healthcare Provider Details

I. General information

NPI: 1659323020
Provider Name (Legal Business Name): BRIDGETTE K POCOCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E CENTRAL AVE
ANDOVER KS
67002-8897
US

IV. Provider business mailing address

308 E CENTRAL AVE
ANDOVER KS
67002-8897
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-1331
  • Fax: 316-733-6846
Mailing address:
  • Phone: 316-733-1331
  • Fax: 316-733-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15-00773
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: