Individual
KEVIN LEE PIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMIN, MDIV, BCC
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-5142
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4295
(318) 990-5142
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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