Healthcare Provider Details

I. General information

NPI: 1700913910
Provider Name (Legal Business Name): STEPHEN G KAY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LINE AVE SUITE 200
SHREVEPORT LA
71101-4639
US

IV. Provider business mailing address

1500 LINE AVE SUITE 204
SHREVEPORT LA
71101-4639
US

V. Phone/Fax

Practice location:
  • Phone: 318-629-5555
  • Fax: 318-629-5556
Mailing address:
  • Phone: 318-629-5001
  • Fax: 318-629-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.A10443
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA10443
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: