Provider Demographics
NPI:1588124457
Name:MORRIS, BRIDGIT EVELYN
Entity type:Individual
Prefix:
First Name:BRIDGIT
Middle Name:EVELYN
Last Name:MORRIS
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 1:29 AVENUE OF CHAMPIONS
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9720
Mailing Address - Country:US
Mailing Address - Phone:606-584-8926
Mailing Address - Fax:
Practice Address - Street 1:1412 TROTWOOD AVE STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4983
Practice Address - Country:US
Practice Address - Phone:931-381-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032242122300000X
390200000X
TN11278122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program