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NPI Code Detail

MEDICARE: MRS. KATHRYN CHREENE WALDROP PA-C

MEDICARE:  MRS. KATHRYN CHREENE WALDROP  PA-C
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
1363A00000XPhysician AssistantPA.200749LA
2363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1336543420
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN CHREENE WALDROP PA-C
Provider Business Mailing Address
First Line : 1449 E BERT KOUNS INDUSTRIAL LOOP STE 101
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5663
Country : US
Telephone Number : 318-681-4282
Fax Number : 318-681-4168
Provider Business Practice Location Address
First Line : 949 OLIVE ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2103
Country : US
Telephone Number : 318-222-3132
Fax Number : 318-222-3865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2014
Last Update Date : 06/04/2026

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Directions to “ MRS. KATHRYN CHREENE WALDROP PA-C” Practice Location

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