Individual
MR. KENTUCKY R SKINNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O-PA/C
Contact information
Practice address
230 AUDUBON DR, MANDEVILLE, LA 70471
(985) 845-1501
(985) 845-1601
Mailing address
230 AUDUBON DR, MANDEVILLE, LA 70471
(985) 845-1501
(985) 845-1601
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
CN88759
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN88759
NC OF ASSIST SURGEONS
LA
Enumeration date
05/17/2007
Last updated
10/18/2008
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