Provider Demographics
NPI:1831556018
Name:BRIDGERS, CHARLA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:BRIDGERS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:CHARLA
Other - Middle Name:CANDACE
Other - Last Name:WAUQUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 155
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-9530
Mailing Address - Country:US
Mailing Address - Phone:580-483-7261
Mailing Address - Fax:
Practice Address - Street 1:3811 W GORE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6328
Practice Address - Country:US
Practice Address - Phone:580-510-7076
Practice Address - Fax:580-510-7081
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0080885163W00000X
OK212001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse