Provider Demographics
NPI:1902803497
Name:BRIDGES, LISA MICHELE (RNC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GRACEY
Mailing Address - State:KY
Mailing Address - Zip Code:42232-9702
Mailing Address - Country:US
Mailing Address - Phone:270-235-9387
Mailing Address - Fax:
Practice Address - Street 1:415 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0713
Practice Address - Country:US
Practice Address - Phone:270-538-0772
Practice Address - Fax:270-538-0773
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1051798163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health