Provider Demographics
NPI:1992766182
Name:BRIDGES, KAYLA D (PD)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:D
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 SCALES RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6470
Mailing Address - Country:US
Mailing Address - Phone:318-728-0828
Mailing Address - Fax:318-248-3399
Practice Address - Street 1:252 HIGHWAY 132
Practice Address - Street 2:
Practice Address - City:MANGHAM
Practice Address - State:LA
Practice Address - Zip Code:71259-5268
Practice Address - Country:US
Practice Address - Phone:318-248-3338
Practice Address - Fax:318-248-3399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15199OtherPHARMACY LIC