Basic Information
| Provider Information | |||||||||
| NPI: | 1982015442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | BRIDGETT | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2585 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257031642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046971396 | ||||||||
| FaxNumber: | 3046972086 | ||||||||
| Practice Location | |||||||||
| Address1: | 408 ALEXANDER STREET | ||||||||
| Address2: | |||||||||
| City: | CEDAR GROVE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253092530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045951770 | ||||||||
| FaxNumber: | 3045953298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2014 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN70687-FNP-BC | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3810027692 | 05 | WV | MEDICAID |