Provider Demographics
NPI:1093044752
Name:MITCHELL, BRIDGETTE DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:DAWN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:SEAL
Other - Last Name:WARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 122425
Mailing Address - Street 2:DEPT 2425
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2425
Mailing Address - Country:US
Mailing Address - Phone:337-494-4720
Mailing Address - Fax:337-494-4721
Practice Address - Street 1:2770 3RD AVE STE 225
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8994
Practice Address - Country:US
Practice Address - Phone:337-494-4720
Practice Address - Fax:337-494-4721
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B351Medicare PIN