Provider Demographics
NPI:1427088988
Name:DEAN, KATHERINE LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LESLIE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 KINGS HWY STE 420
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3950
Mailing Address - Country:US
Mailing Address - Phone:318-212-8727
Mailing Address - Fax:318-212-8771
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-742-5800
Practice Address - Fax:318-741-3902
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD023626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1486655Medicaid
LA1486655Medicaid
LA4A509Medicare ID - Type Unspecified