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General NPI Number Information
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NPI Number | 1831556018
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Entity Type | Individual
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Provider Name | CHARLA BRIDGERS APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 3811 W GORE BLVD STE 10
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City | LAWTON
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State | OK
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Zip | 73505-6328
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Country | US
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Telephone | 580-510-7076
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Fax | 580-510-7081
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Provider Business Mailing Address
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Address Line | RR 3 BOX 155
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City | WALTERS
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State | OK
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Zip | 73572-9530
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Country | US
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Telephone | 580-483-7261
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0080885
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 212001
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License Number State | OK
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