Healthcare Provider Details

I. General information

NPI: 1538080643
Provider Name (Legal Business Name): REBMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 WALNUT ST STE D
AMITE LA
70422-2055
US

IV. Provider business mailing address

309 WALNUT ST STE D
AMITE LA
70422-2055
US

V. Phone/Fax

Practice location:
  • Phone: 985-748-5158
  • Fax: 985-748-9942
Mailing address:
  • Phone: 985-748-5158
  • Fax: 985-748-9942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CANDACE R BRIDGES
Title or Position: NP
Credential: NP
Phone: 985-748-3275