MEDICARE: MS. KELLY LINER DUKE P.A.

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	363AM0700X	Medical Physician Assistant	200058	LA

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
2	200058	OTHER	LA	STATE LICENSE
3	055655	OTHER	LA	CDS
4	TPA132	OTHER	LA	STATE MEDICAL LIC

General Provider Information

NPI Number	:	1376522425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY LINER DUKE P.A.

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	:	225-526-0001
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	2647 S SAINT ELIZABETH BLVD STE 125
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5020
Country	:	US
Telephone Number	:	225-647-9675
Fax Number	:	225-766-2226

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	03/07/2023

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Directions to “ MS. KELLY LINER DUKE P.A.” Practice Location

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