Healthcare Provider Details

I. General information

NPI: 1841269743
Provider Name (Legal Business Name): JUANITA FELTON BRIDGES M.S.,L.D.N.,R.D.,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUANITA FELTON BRIDGES MS, LDN, RD, CDE

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 EAST STONER AVENUE, #120 OVERTON BROOKS VA MEDICAL CENTER
SHREVEPORT LA
71101
US

IV. Provider business mailing address

510 EAST STONER AVENUE, #120 VETERAN AFFAIRS MEDICAL CENTER
SHREVEPORT LA
71101
US

V. Phone/Fax

Practice location:
  • Phone: 318-990-5189
  • Fax: 318-990-5724
Mailing address:
  • Phone: 318-990-5189
  • Fax: 318-990-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: