Healthcare Provider Details

I. General information

NPI: 1629403837
Provider Name (Legal Business Name): BRIDGET MATRICE WALDRUP-SIMPSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 05/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SAINT JOHN ST
LAFAYETTE LA
70501-5707
US

IV. Provider business mailing address

PO BOX 5302
LAFAYETTE LA
70502-5302
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN118240
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07546
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: