Individual
KENNETH BETZING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4573
(318) 798-4651
Mailing address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4573
(318) 798-4651
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.A10262.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053315846
GROUP NPI NUMBER
LA
05
—
1622443
—
LA
01
—
P00997008
RAILROAD MEDICARE
LA
Enumeration date
08/25/2005
Last updated
05/08/2013
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