Provider Demographics
NPI:1801425087
Name:BRISCOE, KAITLYN P (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:P
Last Name:BRISCOE
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 1:500 S 6TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4470
Mailing Address - Country:US
Mailing Address - Phone:337-239-8000
Mailing Address - Fax:337-239-8003
Practice Address - Street 1:500 S 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4470
Practice Address - Country:US
Practice Address - Phone:337-239-8000
Practice Address - Fax:337-239-8003
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA322198363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical