Provider Demographics
NPI:1649677469
Name:HAYES, BRIDGET DAVIS (RN)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:DAVIS
Last Name:HAYES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LAKE VIEW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-8833
Mailing Address - Country:US
Mailing Address - Phone:843-756-6503
Mailing Address - Fax:843-716-3501
Practice Address - Street 1:121 LAKE VIEW RIDGE DR
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-8833
Practice Address - Country:US
Practice Address - Phone:843-756-6503
Practice Address - Fax:843-716-3501
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100965163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0780111917Medicaid