Healthcare Provider Details

I. General information

NPI: 1699769026
Provider Name (Legal Business Name): AMANDA LYNN KAMPERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA BUSBY KAMPERT MD

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 FAIRFIELD AVE
SHREVEPORT LA
71101-4436
US

IV. Provider business mailing address

8493 TANYA DR
GREENWOOD LA
71033-3337
US

V. Phone/Fax

Practice location:
  • Phone: 318-828-2210
  • Fax: 318-828-2215
Mailing address:
  • Phone: 318-938-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.025809
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number025809
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: