Provider Demographics
NPI:1023432697
Name:CASILLAS, BRIDGETTE (LPN)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1487
Mailing Address - Country:US
Mailing Address - Phone:501-454-5476
Mailing Address - Fax:
Practice Address - Street 1:410 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1487
Practice Address - Country:US
Practice Address - Phone:501-454-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL50222164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse