Provider Demographics
NPI:1619646759
Name:MEYERS, BRIDGET FORETIA
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:FORETIA
Last Name:MEYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18420 CLEAR SMOKE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4342
Mailing Address - Country:US
Mailing Address - Phone:301-237-3545
Mailing Address - Fax:
Practice Address - Street 1:18420 CLEAR SMOKE RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-4342
Practice Address - Country:US
Practice Address - Phone:301-237-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2018006547363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty