Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD.202250 | LA |
Y | 111NI0900X | Internist | MD.202250 | LA |
N | 207RH0002X | Hospice and Palliative Medicine | MD.202250 | LA |
NPI | 1033251400 |
---|---|
Provider Name | Dr. Kelly Ryder Letsinger |
First Address | Irving, TX 75038-3813 |
Second Address | Alexandria, LA 71301-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1343412 | (05) | LA |
1K0937 | MEDICARE (01) | LA |