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MRS. CASEY HARRIS PAYNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200090
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1805963
LA
05
336774001
TX
Enumeration date
11/08/2006
Last updated
06/23/2023
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