Provider Demographics
NPI:1457750366
Name:LEBLANC, EMILY K (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1910
Mailing Address - Country:US
Mailing Address - Phone:318-212-7960
Mailing Address - Fax:318-212-7965
Practice Address - Street 1:2449 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-212-7960
Practice Address - Fax:318-212-7965
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200775363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2373072Medicaid
LA2373072Medicaid