Provider Demographics
NPI:1568612240
Name:BRIDEN, KIM MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:BRIDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:PAGENDARM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3724 NATIONAL DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612
Mailing Address - Country:US
Mailing Address - Phone:919-781-9565
Mailing Address - Fax:919-781-9564
Practice Address - Street 1:13805 APPLING LANE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278
Practice Address - Country:US
Practice Address - Phone:704-504-8307
Practice Address - Fax:704-504-8307
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2395171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor