Provider Demographics
NPI:1124396403
Name:KRIEGER, BRYAN JAMES (NP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:KRIEGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 CORPORATE SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-649-1152
Mailing Address - Fax:985-643-9808
Practice Address - Street 1:1839 COOPER RD STE 100
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2835
Practice Address - Country:US
Practice Address - Phone:769-242-1700
Practice Address - Fax:769-242-2148
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06578363L00000X
MS902029363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner