Provider Demographics
NPI:1245491125
Name:JOHNSON, BRIDGET ANNE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:ANNE
Other - Last Name:DORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3439
Mailing Address - Country:US
Mailing Address - Phone:414-405-2957
Mailing Address - Fax:
Practice Address - Street 1:3875 GEIST RD
Practice Address - Street 2:SUITE E381
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3549
Practice Address - Country:US
Practice Address - Phone:907-458-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical