Provider Demographics
NPI:1881298545
Name:BURK, BRIDGITT LYNN
Entity type:Individual
Prefix:
First Name:BRIDGITT
Middle Name:LYNN
Last Name:BURK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5762
Mailing Address - Country:US
Mailing Address - Phone:740-961-8261
Mailing Address - Fax:
Practice Address - Street 1:486 HAMMERSTEIN RD # 186
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8430
Practice Address - Country:US
Practice Address - Phone:740-961-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0168903146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410712OtherDEPARTMENT OF DISABILITY