Healthcare Provider Details

I. General information

NPI: 1790605863
Provider Name (Legal Business Name): BRAILYN BERGERON WOODS BSN, RN, CCRN-CSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 SAM SIBLEY DR
NATCHITOCHES LA
71497-0001
US

IV. Provider business mailing address

175 SAM SIBLEY DR
NATCHITOCHES LA
71497-0001
US

V. Phone/Fax

Practice location:
  • Phone: 318-357-6011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number209558
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236051
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN04820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: