Healthcare Provider Details

I. General information

NPI: 1891203204
Provider Name (Legal Business Name): BRIDGET KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 03/17/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HERSEY ST
HINGHAM MA
02043-2735
US

IV. Provider business mailing address

70 BIRCHWOOD ST
WEST ROXBURY MA
02132-6302
US

V. Phone/Fax

Practice location:
  • Phone: 781-366-2921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2314637
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2314637
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: