Provider Demographics
NPI:1386013670
Name:JOHN S KILPATRICK MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN S KILPATRICK MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-216-3040
Mailing Address - Street 1:745 OLIVE ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2250
Mailing Address - Country:US
Mailing Address - Phone:318-216-3040
Mailing Address - Fax:318-216-3614
Practice Address - Street 1:745 OLIVE ST STE 207
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2250
Practice Address - Country:US
Practice Address - Phone:318-216-3040
Practice Address - Fax:318-216-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015694207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty