Provider Demographics
NPI:1336543420
Name:WALDROP, KATHRYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:WALDROP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:FRANCES
Other - Last Name:CHREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:949 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2103
Mailing Address - Country:US
Mailing Address - Phone:318-222-3132
Mailing Address - Fax:318-222-3865
Practice Address - Street 1:949 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2103
Practice Address - Country:US
Practice Address - Phone:318-222-3132
Practice Address - Fax:318-222-3865
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
LAPA.200749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2377078Medicaid