MEDICARE: DR. AMY LYNETTE KISNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	19549	WV
2	207R00000X	Internal Medicine Physician	19549	WV
3	207R00000X	Internal Medicine Physician	MD.204734	LA
4	208000000X	Pediatrics Physician	MD.204734	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00009580	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326048562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LYNETTE KISNER MD

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-765-5500
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	2647 S SAINT ELIZABETH BLVD STE 308
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5020
Country	:	US
Telephone Number	:	225-765-5500
Fax Number	:	225-765-9419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	12/05/2025

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Directions to “ DR. AMY LYNETTE KISNER MD” Practice Location

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