Provider Demographics
NPI:1396581195
Name:BRIDGETT, KAYLA J (NP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:J
Last Name:BRIDGETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SIERRA BLVD APT 89
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4823
Mailing Address - Country:US
Mailing Address - Phone:510-610-3400
Mailing Address - Fax:
Practice Address - Street 1:2801 K ST STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5118
Practice Address - Country:US
Practice Address - Phone:916-779-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030014363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner