Provider Demographics
NPI:1699769026
Name:KAMPERT, AMANDA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNN
Last Name:KAMPERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BUSBY
Other - Last Name:KAMPERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8493 TANYA DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3337
Mailing Address - Country:US
Mailing Address - Phone:318-938-5660
Mailing Address - Fax:
Practice Address - Street 1:1919 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4436
Practice Address - Country:US
Practice Address - Phone:318-828-2210
Practice Address - Fax:318-828-2215
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.025809208000000X
LA025809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1046345Medicaid