Provider Demographics
NPI:1457841025
Name:SINGLETON, KODY EDMOND (PA)
Entity Type:Individual
Prefix:MR
First Name:KODY
Middle Name:EDMOND
Last Name:SINGLETON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 OAK CREEK RD APT B315
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5841
Mailing Address - Country:US
Mailing Address - Phone:318-533-0445
Mailing Address - Fax:
Practice Address - Street 1:1014 SAINT CLAIR BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5027
Practice Address - Country:US
Practice Address - Phone:225-743-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant