Individual
AMY M BOZEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200677
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2348221
—
LA
01
—
329917YH54
MEDICARE - PTAN
LA
Enumeration date
11/02/2013
Last updated
12/02/2014
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