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NPI Code Detail

MEDICARE: MS. KELLY G WHITE PA-C

MEDICARE: MS. KELLY G WHITE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0003XHematology & Oncology PhysicianPA.A10535LA
2363AM0700XMedical Physician AssistantA10535LA

General Provider Information

NPI Number : 1063415180
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KELLY G WHITE PA-C
Provider Business Mailing Address
First Line : PO BOX 8255
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71306-1255
Country : US
Telephone Number : 318-442-2232
Fax Number : 318-442-2192
Provider Business Practice Location Address
First Line : 605B MEDICAL CENTER DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71301-8127
Country : US
Telephone Number : 318-442-2232
Fax Number : 318-442-2192
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 08/07/2024

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