Individual
MRS. MICHELLE ANNE BURGOYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7045 YOUREE DR, SHREVEPORT, LA 71105-5108
(318) 798-3763
(318) 798-2267
Mailing address
7045 YOUREE DR, SHREVEPORT, LA 71105-5108
(318) 798-3763
(318) 798-2267
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200211
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1325619
—
LA
Enumeration date
10/06/2008
Last updated
02/28/2013
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