Provider Demographics
NPI:1871487389
Name:BRIDGES, HEATHER (SNM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:SNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17364 S 569 RD
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-1813
Mailing Address - Country:US
Mailing Address - Phone:918-457-0324
Mailing Address - Fax:
Practice Address - Street 1:17364 S 569 RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-1813
Practice Address - Country:US
Practice Address - Phone:918-457-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program