Basic Information
| Provider Information | |||||||||
| NPI: | 1629684196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUEGGEMANN | ||||||||
| FirstName: | MEREDITH | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 THOMAS MORE PKWY STE 260 | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599570700 | ||||||||
| FaxNumber: | 8599570703 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 THOMAS MORE PKWY STE 260 | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599570700 | ||||||||
| FaxNumber: | 8599570703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2020 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1149675 | KY | N | Nursing Service Providers | Registered Nurse | 363L00000X | 3015178 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.