Provider Demographics
NPI:1073738936
Name:SPIKES, PAULA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:NICOLE
Last Name:SPIKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:NICOLE
Other - Last Name:JEANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1455 E BERT KOUN LOOP # 200
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5634
Mailing Address - Country:US
Mailing Address - Phone:318-798-4458
Mailing Address - Fax:318-798-4474
Practice Address - Street 1:1455 E BERT KOUNS LOOP
Practice Address - Street 2:#109
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-798-4458
Practice Address - Fax:318-798-4474
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1133469Medicaid