Provider Demographics
NPI:1780938365
Name:BRIDGETT, KEISHA LANEE (STNA)
Entity type:Individual
Prefix:MS
First Name:KEISHA
Middle Name:LANEE
Last Name:BRIDGETT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 PULTE ST
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-1930
Mailing Address - Country:US
Mailing Address - Phone:513-787-1418
Mailing Address - Fax:
Practice Address - Street 1:1729 PULTE ST
Practice Address - Street 2:FLOOR 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1930
Practice Address - Country:US
Practice Address - Phone:513-787-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400552951106376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide