MEDICARE: BRIDGETT N BRANTLEY APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A004297	AR

General Provider Information

NPI Number	:	1619368420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETT N BRANTLEY APRN

Provider Business Mailing Address
First Line	:	1661 AIRPORT RD STE D
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-8184
Country	:	US
Telephone Number	:	501-625-7500
Fax Number	:	501-625-7777

Provider Business Practice Location Address
First Line	:	1629 AIRPORT RD STE B
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-8069
Country	:	US
Telephone Number	:	501-767-0075
Fax Number	:	501-760-2739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	01/10/2019

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