Provider Demographics
NPI:1356302947
Name:KEAST, BRIDGET A (PA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:KEAST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750
Mailing Address - Country:US
Mailing Address - Phone:405-375-6355
Mailing Address - Fax:405-375-6374
Practice Address - Street 1:1002 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750
Practice Address - Country:US
Practice Address - Phone:405-375-6355
Practice Address - Fax:405-375-6374
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100198870AMedicaid
OKPA002833Medicare PIN
OKS07253Medicare UPIN
OK100198870DMedicaid
OK243327603Medicare PIN
OK24H618614Medicare PIN
OK100198870CMedicaid
OK970020164Medicare PIN
OK100198870BMedicaid