MEDICARE: KELSEY AUSTIN ELLENDER-BARTHEL 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
1	363A00000X	Physician Assistant	310469	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

General Provider Information

NPI Number	:	1629552625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY AUSTIN ELLENDER-BARTHEL PA

Provider Business Mailing Address
First Line	:	8001 YOUREE DR STE 350
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2326
Country	:	US
Telephone Number	:	318-212-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 YOUREE DR STE 350
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71115-2326
Country	:	US
Telephone Number	:	318-212-3369
Fax Number	:

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

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	02/26/2024

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Directions to “ KELSEY AUSTIN ELLENDER-BARTHEL PA” Practice Location

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