Provider Demographics
NPI:1235236852
Name:JOHNSON, BRIDGET COLETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:COLETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
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 148
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0148
Mailing Address - Country:US
Mailing Address - Phone:270-504-1300
Mailing Address - Fax:270-504-1980
Practice Address - Street 1:1313 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8957
Practice Address - Country:US
Practice Address - Phone:270-274-9928
Practice Address - Fax:270-274-0134
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004698P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000384686OtherBCBS PROVIDER NUMBER
KY78015393Medicaid
KY4698POtherLICENSE
KY78015393Medicaid
000000384686OtherBCBS PROVIDER NUMBER
KY4698POtherLICENSE
Q56463Medicare UPIN