Provider Demographics
NPI:1841634755
Name:LINCOLN, KILEE HEARD (MD)
Entity type:Individual
Prefix:
First Name:KILEE
Middle Name:HEARD
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:OB/GYN
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-8700
Mailing Address - Fax:318-675-8706
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:OB/GYN
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-675-8700
Practice Address - Fax:318-675-8706
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA304920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2331604Medicaid