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General NPI Number Information
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NPI Number | 1174959779
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Entity Type | Individual
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Provider Name | KENDALL THOMAS PILGREEN P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1111 LINE AVE 3RD FLOOR TOWER 2
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City | SHREVEPORT
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State | LA
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Zip | 71101
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Country | US
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Telephone | 318-716-4610
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Fax | 318-716-4690
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Provider Business Mailing Address
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Address Line | 1202 LOUISIANA AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-3910
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Country | US
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Telephone | 318-212-8574
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Fax | 318-212-4153
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.200647
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License Number State | LA
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