Provider Demographics
NPI:1629187422
Name:KILPATRICK, JOHN STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
Last Name:KILPATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 OLIVE ST
Mailing Address - Street 2:STE 207
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015694207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1327247Medicaid
LA1327247Medicaid
LA50588C552Medicare PIN