Healthcare Provider Details

I. General information

NPI: 1598991853
Provider Name (Legal Business Name): BRIDGETTE LOREEN CARROLL APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGETTE LOREEN CARROLL APRN, FNP-C

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 W HIGHWAY 22
CRESTWOOD KY
40014-9305
US

IV. Provider business mailing address

6210 CAMDEN CIR
CRESTWOOD KY
40014-8847
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-8488
  • Fax: 502-241-7424
Mailing address:
  • Phone: 502-724-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006186
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: