Provider Demographics
NPI:1053928622
Name:CHAPMAN, KENNEDY POOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KENNEDY
Middle Name:POOLE
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6569 HWY 84
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-4551
Mailing Address - Country:US
Mailing Address - Phone:318-757-6559
Mailing Address - Fax:318-757-6559
Practice Address - Street 1:6569 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-4573
Practice Address - Country:US
Practice Address - Phone:318-757-6559
Practice Address - Fax:318-757-7014
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324530363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2543890Medicaid