Provider Demographics
NPI:1568992378
Name:BRIDGES, CHARITY R (LPN)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:R
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E MEEK ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:OK
Mailing Address - Zip Code:73095-3340
Mailing Address - Country:US
Mailing Address - Phone:405-412-2869
Mailing Address - Fax:
Practice Address - Street 1:1904 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4248
Practice Address - Country:US
Practice Address - Phone:580-622-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23001261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherSOCIAL SECURITY COMMISSION