Provider Demographics
NPI:1336725142
Name:NOBLE, BRIDGETTE MICHELLE (DO)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MICHELLE
Last Name:NOBLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:MICHELLE
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2405 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-5007
Mailing Address - Country:US
Mailing Address - Phone:817-773-5034
Mailing Address - Fax:
Practice Address - Street 1:1110 SE 30TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4290
Practice Address - Country:US
Practice Address - Phone:479-282-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE17890208000000X
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program