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General NPI Number Information
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NPI Number | 1447910054
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Entity Type | Individual
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Provider Name | KAYLA BRIDGEWATER APRN
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Gender | Female
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 1430 K ST NW # 102
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City | WASHINGTON
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State | DC
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Zip | 20005-2504
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Country | US
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Telephone | 703-337-3483
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Fax |
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Provider Business Mailing Address
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Address Line | 8558 MAIN ST
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City | SORRENTO
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State | LA
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Zip | 70778-3022
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Country | US
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Telephone | 504-547-1093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 221850
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP500009368
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License Number State | DC
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