Individual
KASI LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-8527
Mailing address
2751 ALBERT L BICKNELL DR STE 3D, SHREVEPORT, LA 71103-3941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
03/28/2025
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