Provider Demographics
NPI:1134901440
Name:BRIDGES-WARD, KISHA REGINA
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:REGINA
Last Name:BRIDGES-WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 IRVING ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2850
Mailing Address - Country:US
Mailing Address - Phone:202-230-2657
Mailing Address - Fax:
Practice Address - Street 1:1400 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2850
Practice Address - Country:US
Practice Address - Phone:202-230-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator