Provider Demographics
NPI:1679849376
Name:THOMPSON, BRIDGET LEE (AGACNP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MRS
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:PILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-2219
Practice Address - Country:US
Practice Address - Phone:920-988-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI176153-30163W00000X
TX1014606363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse