Healthcare Provider Details

I. General information

NPI: 1114170529
Provider Name (Legal Business Name): RORI E. BRIDGES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BROAD ST
FOREST MS
39074-3508
US

IV. Provider business mailing address

PO BOX 520
MARION MS
39342-0520
US

V. Phone/Fax

Practice location:
  • Phone: 601-469-4771
  • Fax: 601-469-4724
Mailing address:
  • Phone: 601-646-7700
  • Fax: 888-735-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR851066
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: