MEDICARE: MRS. CANDACE RAY BRIDGES APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	210921	LA

General Provider Information

NPI Number	:	1841839966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CANDACE RAY BRIDGES APRN, FNP-C

Provider Business Mailing Address
First Line	:	705 SHERRI DR
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-2054
Country	:	US
Telephone Number	:	985-247-5023
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 WALNUT ST STE D
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-2055
Country	:	US
Telephone Number	:	985-247-5023
Fax Number	:	985-748-9942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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