Provider Demographics
NPI:1528602372
Name:LANDRY, KENDRA LOUISE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:LOUISE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 MACKEY LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2556
Mailing Address - Country:US
Mailing Address - Phone:225-324-1302
Mailing Address - Fax:
Practice Address - Street 1:2709 MACKEY LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2556
Practice Address - Country:US
Practice Address - Phone:318-671-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics