Provider Demographics
NPI:1942293998
Name:WHITFIELD, MALINDA BRIDGES (FNP, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:BRIDGES
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:PENN LAIRD
Mailing Address - State:VA
Mailing Address - Zip Code:22846-9617
Mailing Address - Country:US
Mailing Address - Phone:318-518-1157
Mailing Address - Fax:757-579-8573
Practice Address - Street 1:3841 BULL RUN RD
Practice Address - Street 2:
Practice Address - City:PENN LAIRD
Practice Address - State:VA
Practice Address - Zip Code:22846-9617
Practice Address - Country:US
Practice Address - Phone:318-518-1157
Practice Address - Fax:757-579-8573
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04506363LF0000X
VA0024175918363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1804053Medicaid
VA1942293998Medicaid