Patricia E Bridgewater, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1999140492 Issued in MO

Practice address

1819 West Austin, Suite C
Nevada, MO 64772-2202

Phone

(417) 283-6151

Fax

(417) 283-6152

NPI assigned

Oct 26, 2006

Last updated

Feb 24, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellness Company VII

  • Clinical Psychologist
  • Nevada, MO
  • NPI 1659625937
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393200000000",
    "number": "1356426308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1819 W AUSTIN BLVD STE C",
            "address_2": "PO BOX 177",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647723708",
            "telephone_number": "417-283-6151",
            "fax_number": "417-283-6152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1819 WEST AUSTIN, SUITE C",
            "city": "NEVADA",
            "state": "MO",
            "postal_code": "647722202",
            "telephone_number": "417-283-6151",
            "fax_number": "417-283-6152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGEWATER",
        "first_name": "PATRICIA",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2014-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "1999140492",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011168",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494768302",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jama Jelaine Bogart, FNP
• Cody Lee Bond, PSY.D., LCP
• Cassie Jo Boultinghouse, RDH
• Chrystie Lyn Braden, MS, PLPC
• Cindy Layne Brannan, RN
• Melissa Marie Briggs, LPC
• Bristol Care, Inc.
• Karen Brower, MAADC1
• Casey Lauren Brown, APRN
• Thomas Richard Bunton, D.D.S.

• Clinical Psychologist in Nevada, MO
• Providers in Nevada, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.