Healthcare Provider Details

I. General information

NPI: 1124396403
Provider Name (Legal Business Name): BRYAN JAMES KRIEGER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 COOPER RD STE 100
PICAYUNE MS
39466-2835
US

IV. Provider business mailing address

1375 CORPORATE SQUARE DRIVE
SLIDELL LA
70458
US

V. Phone/Fax

Practice location:
  • Phone: 769-242-1700
  • Fax: 769-242-2148
Mailing address:
  • Phone: 985-649-1152
  • Fax: 985-643-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06578
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902029
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: