Healthcare Provider Details

I. General information

NPI: 1487906277
Provider Name (Legal Business Name): JEREMY J. CAUSEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 LANDRY DR
BOSSIER CITY LA
71111-3169
US

IV. Provider business mailing address

1534 ELIZABETH AVE STE 301
SHREVEPORT LA
71101-4531
US

V. Phone/Fax

Practice location:
  • Phone: 318-752-7850
  • Fax: 318-752-7855
Mailing address:
  • Phone: 318-629-5002
  • Fax: 318-629-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.#792.EXAM
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number200591
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: