Provider Demographics
NPI:1306862123
Name:BRIDGES, BAYLISSA MYLES (PA)
Entity Type:Individual
Prefix:MS
First Name:BAYLISSA
Middle Name:MYLES
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 HOSPITAL ST
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5312
Mailing Address - Country:US
Mailing Address - Phone:228-938-0700
Mailing Address - Fax:228-938-0705
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 112B
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-938-0700
Practice Address - Fax:228-938-0705
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA274363AM0700X
MSPA032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04375734Medicaid
AL515-17285OtherBLUE CROSS OF ALABAMA
MS04375734Medicaid
AL515-17285OtherBLUE CROSS OF ALABAMA