Active NPI
Misty M Bridges, OM
- Specialist
- Tyler, TX
National Provider Identifier
1093032880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 7882
- Practice address
- 106 E Heritage Dr Ste 5E
Tyler, TX 75703-5112 - Phone
- (903) 245-8667
- Fax
- (903) 595-4639
- NPI assigned
- May 3, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 7882 | TX | Primary |
Addresses
Primary practice location
106 E Heritage Dr Ste 5E
Tyler, TX 75703-5112
Mailing address
106 E Heritage Dr Ste 5E
Tyler, TX 75703-5112
Phone (903) 245-8667
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7882 | TX | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272844800000",
"number": "1093032880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 E HERITAGE DR STE 5E",
"city": "TYLER",
"state": "TX",
"postal_code": "757035112",
"telephone_number": "903-245-8667",
"fax_number": "903-595-4639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 E HERITAGE DR STE 5E",
"city": "TYLER",
"state": "TX",
"postal_code": "757035112",
"telephone_number": "903-245-8667",
"fax_number": "903-595-4639"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRIDGES",
"first_name": "MISTY",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "OM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-03",
"last_updated": "2010-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "TX",
"license": "7882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.