Individual
ELAINE BURGESS DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1500 LINE AVE, STE 100, SHREVEPORT, LA 71101
(318) 635-3052
(318) 632-6087
Mailing address
1534 ELIZABETH AVE, SUITE 201, SHREVEPORT, LA 71101-4516
(318) 629-5002
(318) 629-5020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200138
LA
Other
Enumeration date
10/09/2007
Last updated
12/08/2014
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