Healthcare Provider Details

I. General information

NPI: 1801128616
Provider Name (Legal Business Name): ELISE KAYSER KOWALEWSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 YOUREE DR
SHREVEPORT LA
71105-5127
US

IV. Provider business mailing address

7925 YOUREE DR SUITE 200
SHREVEPORT LA
71105-5127
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-3610
  • Fax: 318-212-3672
Mailing address:
  • Phone: 318-212-3610
  • Fax: 318-212-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA150304
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200535
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: