Provider Demographics
NPI:1295010924
Name:KIRONG, BRIDGET CHEPKOECH (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:CHEPKOECH
Last Name:KIRONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:CHEPKOECH
Other - Last Name:KIPKILEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1137 S DUPREE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-3255
Mailing Address - Country:US
Mailing Address - Phone:731-779-0902
Mailing Address - Fax:731-779-0905
Practice Address - Street 1:1137 S DUPREE AVE STE 400
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-3255
Practice Address - Country:US
Practice Address - Phone:731-779-0902
Practice Address - Fax:731-779-0905
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant