Healthcare Provider Details

I. General information

NPI: 1164723581
Provider Name (Legal Business Name): KIM MICHELLE BRIDGES MSNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

14721 STEPHENSON RD
MORNING VIEW KY
41063-9641
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-2211
  • Fax:
Mailing address:
  • Phone: 859-356-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number086672
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1093910
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: