Provider Demographics
NPI:1295071785
Name:CLARK, BRIDGETTE (MHPP)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:
Other - Last Name:TROTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3348 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-6544
Mailing Address - Country:US
Mailing Address - Phone:870-424-9060
Mailing Address - Fax:870-424-9061
Practice Address - Street 1:3348 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6544
Practice Address - Country:US
Practice Address - Phone:870-424-9060
Practice Address - Fax:870-424-9061
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator