Provider Demographics
NPI:1629684196
Name:BRUEGGEMANN, MEREDITH NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:NICOLE
Last Name:BRUEGGEMANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 THOMAS MORE PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5117
Mailing Address - Country:US
Mailing Address - Phone:859-957-0700
Mailing Address - Fax:859-957-0703
Practice Address - Street 1:340 THOMAS MORE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5117
Practice Address - Country:US
Practice Address - Phone:859-957-0700
Practice Address - Fax:859-957-0703
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1149675163W00000X
KY3015178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse