Healthcare Provider Details

I. General information

NPI: 1093044752
Provider Name (Legal Business Name): BRIDGETTE DAWN MITCHELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIDGETTE SEAL WARDEN

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 3RD AVE STE 225
LAKE CHARLES LA
70601-8994
US

IV. Provider business mailing address

PO BOX 122425 DEPT 2425
DALLAS TX
75312-2425
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-4720
  • Fax: 337-494-4721
Mailing address:
  • Phone: 337-494-4720
  • Fax: 337-494-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP05964
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: