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General NPI Number Information
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NPI Number | 1568992378
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Entity Type | Individual
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Provider Name | CHARITY R BRIDGES LPN
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Gender | Female
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1904 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4248
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Country | US
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Telephone | 580-622-6134
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Fax |
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Provider Business Mailing Address
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Address Line | 105 E MEEK ST
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City | WAYNE
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State | OK
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Zip | 73095-3340
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Country | US
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Telephone | 405-412-2869
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 23001
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License Number State | OK
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