Healthcare Provider Details

I. General information

NPI: 1184588634
Provider Name (Legal Business Name): ALLISON BRIDGES GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON BRIDGES

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE STE 318
BATON ROUGE LA
70809-3749
US

IV. Provider business mailing address

8585 PICARDY AVE STE 318
BATON ROUGE LA
70809-3749
US

V. Phone/Fax

Practice location:
  • Phone: 225-333-3800
  • Fax:
Mailing address:
  • Phone: 225-333-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number217179
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number217179
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: