Individual
DUSTIN KADE BAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1124 CREOLE DR, BOSSIER CITY, LA 71111-8224
(903) 754-9005
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN142451
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
203071
LA
Other
Enumeration date
01/09/2019
Last updated
01/24/2019
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