Provider Demographics
NPI:1629361472
Name:PELKEY TAYLOR, BRIDGET LUE (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:LUE
Last Name:PELKEY TAYLOR
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3666
Mailing Address - Country:US
Mailing Address - Phone:804-824-8849
Mailing Address - Fax:
Practice Address - Street 1:213 N BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3666
Practice Address - Country:US
Practice Address - Phone:804-824-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129-000067176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife