Provider Demographics
NPI:1801128616
Name:KOWALEWSKI, ELISE KAYSER (PA)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:KAYSER
Last Name:KOWALEWSKI
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 1:7925 YOUREE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5127
Mailing Address - Country:US
Mailing Address - Phone:318-212-3610
Mailing Address - Fax:318-212-3709
Practice Address - Street 1:7925 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5127
Practice Address - Country:US
Practice Address - Phone:318-212-3610
Practice Address - Fax:318-212-3672
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA150304363AS0400X
LAPA200535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2193724Medicaid