Provider Demographics
NPI:1720146988
Name:MULLEN, BRIDGET YVETTE (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:YVETTE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:YVETTE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:424 DECATUR ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1848
Mailing Address - Country:US
Mailing Address - Phone:678-843-8500
Mailing Address - Fax:678-843-8501
Practice Address - Street 1:424 DECATUR ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1848
Practice Address - Country:US
Practice Address - Phone:678-843-8500
Practice Address - Fax:678-843-8501
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146011363L00000X
GARN146011NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA755132055DMedicaid
GA755132055CMedicaid
GAQ37824Medicare UPIN