Provider Demographics
NPI:1558661470
Name:BROTHERTON, KENDA BOCKHAUS (NP)
Entity Type:Individual
Prefix:
First Name:KENDA
Middle Name:BOCKHAUS
Last Name:BROTHERTON
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 1:2400 HOSPITAL DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2385
Mailing Address - Country:US
Mailing Address - Phone:318-742-6710
Mailing Address - Fax:318-747-5393
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2385
Practice Address - Country:US
Practice Address - Phone:318-742-6710
Practice Address - Fax:318-747-5393
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05555363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics