Provider Demographics
NPI:1427267236
Name:EASON, KENT WILLIAM (PA-C)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:WILLIAM
Last Name:EASON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51008
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-1008
Mailing Address - Country:US
Mailing Address - Phone:318-798-9400
Mailing Address - Fax:318-798-3894
Practice Address - Street 1:2727 HEARNE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3931
Practice Address - Country:US
Practice Address - Phone:318-798-9400
Practice Address - Fax:318-798-3894
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527572Medicaid
LA57720P743Medicare PIN
LA57720PA71Medicare PIN
LA1527572Medicaid