Provider Demographics
NPI:1720427115
Name:MCKINLEY, BRIDGET (APRN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 RING RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8940
Mailing Address - Country:US
Mailing Address - Phone:270-986-7373
Mailing Address - Fax:
Practice Address - Street 1:1321 RING RD
Practice Address - Street 2:STE 107
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8940
Practice Address - Country:US
Practice Address - Phone:270-986-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008098363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100319440Medicaid