Healthcare Provider Details

I. General information

NPI: 1528084068
Provider Name (Legal Business Name): ABBIE CREIGHTON KEMPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBIE CREIGHTON KEMPER

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF RADIOLOGY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF RADIOLOGY
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-7737
  • Fax: 318-675-5666
Mailing address:
  • Phone: 318-675-7737
  • Fax: 318-675-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number021978
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number021978
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: