Individual
CEDRIC R WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8001 YOUREE DR STE 540, SHREVEPORT, LA 71115-2343
(318) 631-9121
(318) 631-9126
Mailing address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200392
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2128680
—
LA
01
—
PA.200392
STATE LICENSE
LA
Enumeration date
10/27/2010
Last updated
08/12/2022
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