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NPI Code Detail

MEDICARE: MR. KODY EDMOND SINGLETON PA

MEDICARE: MR. KODY EDMOND SINGLETON PA
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 Assistant308917LA

General Provider Information

NPI Number : 1457841025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KODY EDMOND SINGLETON PA
Provider Business Mailing Address
First Line : 2001 OAK CREEK RD APT B315
Second Line :
City : RIVER RIDGE
State : LA
Zip : 70123-5841
Country : US
Telephone Number : 318-533-0445
Fax Number :
Provider Business Practice Location Address
First Line : 1014 SAINT CLAIR BLVD STE 1020
Second Line :
City : GONZALES
State : LA
Zip : 70737-5027
Country : US
Telephone Number : 225-743-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2018
Last Update Date : 05/18/2018

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Directions to “ MR. KODY EDMOND SINGLETON PA” Practice Location

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