Provider Demographics
NPI:1841839966
Name:BRIDGES, CANDACE RAY (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:RAY
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SHERRI DR
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2054
Mailing Address - Country:US
Mailing Address - Phone:985-247-5023
Mailing Address - Fax:
Practice Address - Street 1:309 WALNUT ST STE D
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2055
Practice Address - Country:US
Practice Address - Phone:985-247-5023
Practice Address - Fax:985-748-9942
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine