Healthcare Provider Details

I. General information

NPI: 1790605863
Provider Name (Legal Business Name): MRS. BRAILYN BERGERON WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15065 CROSS CREEK BLVD
WALKER LA
70785-5221
US

IV. Provider business mailing address

15065 CROSS CREEK BLVD
WALKER LA
70785-5221
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-9475
  • Fax:
Mailing address:
  • Phone: 225-588-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: