Provider Demographics
NPI:1366191322
Name:WILIAMS, BRIDGETTE MICHELLE
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MICHELLE
Last Name:WILIAMS
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 1:2513 MCCAIN BLVD.
Mailing Address - Street 2:SUITE 2 PO BOX 212
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-3549
Mailing Address - Country:US
Mailing Address - Phone:501-436-3715
Mailing Address - Fax:
Practice Address - Street 1:704 ELLEN DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-3549
Practice Address - Country:US
Practice Address - Phone:713-480-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756973171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach