Provider Demographics
NPI:1598991853
Name:CARROLL, BRIDGETTE LOREEN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:LOREEN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:LOREEN
Other - Last Name:LINEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:6210 CAMDEN CIR
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8847
Mailing Address - Country:US
Mailing Address - Phone:502-724-9325
Mailing Address - Fax:
Practice Address - Street 1:865 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-9124
Practice Address - Country:US
Practice Address - Phone:502-437-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6186P207Q00000X, 2084N0400X
KY3006186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY113935OtherSIHO NICC
KY000000623052OtherANTHEM
KY3737633000OtherPASSPORT ADVANTAGE
KY50025786OtherPASSPORT
KY000000623052OtherANTHEM
KY50025786OtherPASSPORT