Provider Demographics
NPI:1114222981
Name:MARKERSON, AMY KYGER (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KYGER
Last Name:MARKERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:KYGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1522 CITY PL
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4538
Mailing Address - Country:US
Mailing Address - Phone:417-234-0102
Mailing Address - Fax:225-927-0547
Practice Address - Street 1:3333 DRUSILLA LN
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2418
Practice Address - Country:US
Practice Address - Phone:225-924-4460
Practice Address - Fax:225-927-0547
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200549363A00000X
MO2011001804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2322443Medicaid
LA2322443Medicaid