Individual
W. PHILLIP KINNEBREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2508 BERT KOUNS LOOP, SUITE 102, SHREVEPORT, LA 71118-3133
(318) 688-6630
(318) 688-6014
Mailing address
2508 BERT KOUNS LOOP, SUITE 102, SHREVEPORT, LA 71118-3133
(318) 688-6630
(318) 688-6014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
016341
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1338494
—
LA
Enumeration date
11/07/2005
Last updated
06/17/2021
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