Provider Demographics
NPI:1073859732
Name:CULBERTSON, JOHN COLIN (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:COLIN
Last Name:CULBERTSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3515 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0711
Mailing Address - Country:US
Mailing Address - Phone:903-791-9355
Mailing Address - Fax:903-793-0496
Practice Address - Street 1:4526 NORTHPORT BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2536
Practice Address - Country:US
Practice Address - Phone:318-935-9626
Practice Address - Fax:318-489-4181
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2025-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAPA.200663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA546995YJBAMedicare PIN