Healthcare Provider Details

I. General information

NPI: 1750982138
Provider Name (Legal Business Name): BRIDGET PATRICIA KAMP CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 ROCKSIDE RD
INDEPENDENCE OH
44131-2172
US

IV. Provider business mailing address

2611 UNIVERSITY BLVD
UNIVERSITY HEIGHTS OH
44118-4729
US

V. Phone/Fax

Practice location:
  • Phone: 317-313-9711
  • Fax:
Mailing address:
  • Phone: 317-313-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN.CNP.0027842
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: