Individual
MRS. KIRSTI NICOLE PEAVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2551 GREENWOOD RD, SHREVEPORT, LA 71103-3981
(318) 212-8424
(318) 212-8459
Mailing address
2038 URBANDALE ST, SHREVEPORT, LA 71118-3325
(318) 349-8179
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA200315
LA
Other
Enumeration date
11/12/2009
Last updated
03/30/2016
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