Basic Information
| Provider Information | |||||||||
| NPI: | 1538213186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATLIFF | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 E EH CRUMP BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381265310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012612000 | ||||||||
| FaxNumber: | 9019469262 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 E EH CRUMP BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381265310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012612000 | ||||||||
| FaxNumber: | 9019469262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN84536 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 5440185 | 05 | TN | MEDICAID |