Individual
KENYATTA D. SHAMLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8595 PICARDY AVE, STE 100, BATON ROUGE, LA 70809-3674
(225) 763-4900
(225) 763-4938
Mailing address
8490 PICARDY AVE, BLDG 200, BATON ROUGE, LA 70809-3731
(225) 237-1754
(225) 237-1722
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025911
LA
208000000X
Pediatrics Physician
025911
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110243989
RAILROAD MEDICARE
LA
05
—
1136247
—
LA
Enumeration date
07/01/2005
Last updated
09/14/2020
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