Individual
SHANNON LEA BETZING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2727 HEARNE AVE, SUITE 300, SHREVEPORT, LA 71103-3931
(318) 798-9400
(318) 798-3894
Mailing address
PO BOX 51008, SHREVEPORT, LA 71135-1008
(318) 798-9400
(318) 798-3894
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200377
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2136364
—
LA
Enumeration date
09/27/2010
Last updated
04/09/2012
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