Provider Demographics
NPI:1831633510
Name:LAVIGNE, KERRI (PA-C)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:LAVIGNE
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 1:2727 HEARNE AVE
Mailing Address - Street 2:300
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3917
Mailing Address - Country:US
Mailing Address - Phone:318-798-9400
Mailing Address - Fax:
Practice Address - Street 1:2727 HEARNE AVE
Practice Address - Street 2:300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3917
Practice Address - Country:US
Practice Address - Phone:318-798-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7788363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant