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General NPI Number Information
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NPI Number | 1841839966
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Entity Type | Individual
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Provider Name | CANDACE RAY BRIDGES APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 309 WALNUT ST STE D
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City | AMITE
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State | LA
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Zip | 70422-2055
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Country | US
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Telephone | 985-247-5023
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Fax | 985-748-9942
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Provider Business Mailing Address
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Address Line | 705 SHERRI DR
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City | AMITE
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State | LA
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Zip | 70422-2054
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Country | US
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Telephone | 985-247-5023
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 210921
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License Number State | LA
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