Individual
TINA FAITH GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7925 YOUREE DR SUITE 280B, SHREVEPORT, LA 71105-5538
(318) 212-3636
(318) 212-3649
Mailing address
7925 YOUREE DR SUITE 280B, SHREVEPORT, LA 71105-5538
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A10432
LA
363AM0700X
Medical Physician Assistant
PAA10432
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1722901
—
LA
Enumeration date
07/03/2006
Last updated
04/14/2008
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