Provider Demographics
NPI:1285661181
Name:YERGER, KELLY A (NP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:YERGER
Suffix:
Gender:F
Credentials:NP
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 1736
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71166-1736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 PIERREMONT RD
Practice Address - Street 2:SUITE 234
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2069
Practice Address - Country:US
Practice Address - Phone:318-562-3988
Practice Address - Fax:318-562-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68700-3500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00231748OtherRAILROAD MEDICARE
LA1562360Medicaid
LAS97403Medicare UPIN
LA4B695Medicare PIN