Basic Information
| Provider Information | |||||||||
| NPI: | 1033262829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNHAM BRIDGES | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 RT STANLEY SENIOR PL | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125374986 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 R T STANLEY SR PLACE | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125269355 | ||||||||
| FaxNumber: | 9125268622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN076524 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | RN076524 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.