Healthcare Provider Details

I. General information

NPI: 1902262660
Provider Name (Legal Business Name): BRIDGET DRURY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET KINEALY

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017-3406
US

IV. Provider business mailing address

660 S EUCLID AVE
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-497-1632
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2015022195
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: