Provider Demographics
NPI:1639426158
Name:BRIDGMON, BARBARA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:BRIDGMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 RUSKIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2522
Mailing Address - Country:US
Mailing Address - Phone:719-572-6100
Mailing Address - Fax:719-572-6199
Practice Address - Street 1:6208 LEHMAN DR
Practice Address - Street 2:STE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8408
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:719-572-6080
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44223163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse