Provider Demographics
NPI:1164732590
Name:LEDOUX, STEPHANIE HUNT (PA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:HUNT
Last Name:LEDOUX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:950 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2104
Mailing Address - Country:US
Mailing Address - Phone:318-813-7100
Mailing Address - Fax:318-813-7120
Practice Address - Street 1:950 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2104
Practice Address - Country:US
Practice Address - Phone:318-813-7100
Practice Address - Fax:318-813-7120
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
LAPA200395363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant