Basic Information
| Provider Information | |||||||||
| NPI: | 1659323020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POCOCK | ||||||||
| FirstName: | BRIDGETTE | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 E CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670028897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167331331 | ||||||||
| FaxNumber: | 3167336846 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 E CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670028897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167331331 | ||||||||
| FaxNumber: | 3167336846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 15-00773 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | KS | MEDICAID |