Provider Demographics
NPI:1841269743
Name:BRIDGES, JUANITA FELTON (MS,LDN,RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:FELTON
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:MS,LDN,RD,CDE
Other - Prefix:MRS
Other - First Name:JUANITA
Other - Middle Name:FELTON
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LDN, RD, CDE
Mailing Address - Street 1:510 EAST STONER AVENUE, #120
Mailing Address - Street 2:VETERAN AFFAIRS MEDICAL CENTER
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-990-5189
Mailing Address - Fax:318-990-5724
Practice Address - Street 1:510 EAST STONER AVENUE, #120
Practice Address - Street 2:OVERTON BROOKS VA MEDICAL CENTER
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-990-5189
Practice Address - Fax:318-990-5724
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA16541OtherCDR NUMBER
LA1095OtherLICENSE NUMBER