Provider Demographics
NPI:1477808483
Name:BRIDGEFORTH, CELIA RENE (MPA, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CELIA
Middle Name:RENE
Last Name:BRIDGEFORTH
Suffix:
Gender:F
Credentials:MPA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24705 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-6827
Mailing Address - Country:US
Mailing Address - Phone:225-687-9021
Mailing Address - Fax:225-687-1892
Practice Address - Street 1:24705 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6827
Practice Address - Country:US
Practice Address - Phone:225-687-9021
Practice Address - Fax:225-687-1892
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2077133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist