Healthcare Provider Details

I. General information

NPI: 1932527967
Provider Name (Legal Business Name): BRIDGET KEYS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 WILLIAMS DR
LEAKESVILLE MS
39451-5622
US

IV. Provider business mailing address

PO BOX 475
BILOXI MS
39533-0475
US

V. Phone/Fax

Practice location:
  • Phone: 601-394-2381
  • Fax: 601-394-2593
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-374-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR873568
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: