Provider Demographics
NPI:1164787867
Name:ESPY, BRIDGET ANN
Entity Type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:ANN
Last Name:ESPY
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 1:2801 S VALLEY VIEW BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0176
Mailing Address - Country:US
Mailing Address - Phone:702-629-5815
Mailing Address - Fax:702-629-5815
Practice Address - Street 1:1200 W CHEYENNE AVE APT 1025
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7830
Practice Address - Country:US
Practice Address - Phone:702-917-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV83-2487956Medicaid