Healthcare Provider Details

I. General information

NPI: 1245271469
Provider Name (Legal Business Name): BRIDGET KMETZ CRNP-F
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD HUNTER-MCGUIRE VAMC, ORANGE CLINIC, GPD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

10108 COOL HIVE PL
MECHANICSVILLE VA
23116-2608
US

V. Phone/Fax

Practice location:
  • Phone: 301-751-9466
  • Fax:
Mailing address:
  • Phone: 301-751-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberR132363
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR132363
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: