Healthcare Provider Details

I. General information

NPI: 1992766182
Provider Name (Legal Business Name): KAYLA D BRIDGES P.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 HIGHWAY 132
MANGHAM LA
71259-5268
US

IV. Provider business mailing address

291 SCALES RD
RAYVILLE LA
71269-6470
US

V. Phone/Fax

Practice location:
  • Phone: 318-248-3338
  • Fax: 318-248-3399
Mailing address:
  • Phone: 318-728-0828
  • Fax: 318-248-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15199
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: