Provider Demographics
NPI:1952946097
Name:BRIDGES, JERLENE
Entity Type:Individual
Prefix:
First Name:JERLENE
Middle Name:
Last Name:BRIDGES
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 1:129 JULIUS PRICE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39663-2219
Mailing Address - Country:US
Mailing Address - Phone:601-886-7208
Mailing Address - Fax:
Practice Address - Street 1:129 JULIUS PRICE RD
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:MS
Practice Address - Zip Code:39663-2219
Practice Address - Country:US
Practice Address - Phone:601-886-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3747A0630XOtherVETERANS ADMINISTRATION