Individual
KIMBERLY LYNN SKIDMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
207585
LA
207L00000X
Anesthesiology Physician
A60796
CA
207L00000X
Anesthesiology Physician
N9133
TX
207LP3000X
Pediatric Anesthesiology Physician
207585
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A607960
BLUE SHIELD
CA
05
—
1144247842
—
CA
05
—
1356575138
—
CA
01
—
1942504501
BLUE SHIELD
CA
Enumeration date
07/17/2006
Last updated
06/06/2023
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