Healthcare Provider Details

I. General information

NPI: 1194084152
Provider Name (Legal Business Name): KEVIN JARRELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

211 4TH ST
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 318-769-5000
  • Fax:
Mailing address:
  • Phone: 318-769-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number305422
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number305422
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: