Individual ProviderBridgette RunnelsNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1 Lincoln Pkwy Ste 300, Hattiesburg, MS 39402-3261(601) 296-2870(601) 579-5430PECOS EnrollmentBased on the most recent information from CMS, provider Bridgette Runnels is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1467840736Provider TypeIndividualFull NameRunnels, BridgetteTitleMrs.CredentialFNP-CGenderFemaleSole ProprietorNoEnumeration Date1/8/2015Last Updated7/19/2021Contact InformationPractice LocationPractice Address1 Lincoln Pkwy Ste 300, Hattiesburg, MS 39402-3261Phone(601) 296-2870Fax(601) 579-5240Mailing LocationMailing Address415 S 28th Ave, Hattiesburg, MS 39401-7246Phone(601) 579-5430Fax(601) 579-5431Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense893522MississippiCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense893522MississippiProvider IdentifiersIDDescriptionIssuerID00771500DescriptionMedicaidIssuerUnlistedMississippi