Provider Demographics
NPI:1568996213
Name:FRANKLIN, BRIDGET (PA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-866-2460
Mailing Address - Fax:636-866-2450
Practice Address - Street 1:2050 1ST CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1647
Practice Address - Country:US
Practice Address - Phone:636-866-2460
Practice Address - Fax:636-866-2450
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant