Provider Demographics
NPI:1164446274
Name:CUNNINGHAM, BRIDGETT L (BCFNP)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:L
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:BCFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:5 E ALVON ROAD SUITE 7
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-2373
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-399-7484
Practice Address - Fax:304-399-7484
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2851605Medicaid
KY7100066230Medicaid
WV7104198000Medicaid
WV1062972OtherBRICK STREET (WV COMP)
WV1164446274OtherMTN BCBS
WV1164446274OtherMTN BCBS
WV7104198000Medicaid
WVP94510Medicare UPIN