Healthcare Provider Details

I. General information

NPI: 1144504796
Provider Name (Legal Business Name): REBECCA ESKEW CLAWSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA JANE ESKEW

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY SAHP PA PROGRAM
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

PO BOX 33932 SAHP PA PROGRAM
SHREVEPORT LA
71130-3932
US

V. Phone/Fax

Practice location:
  • Phone: 318-813-2927
  • Fax: 318-813-2915
Mailing address:
  • Phone: 318-813-2927
  • Fax: 318-813-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200481
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: