| Ms Kelly Liner Duke, PA | |
|
2647 S Saint Elizabeth Blvd Ste 125, Gonzales, LA 70737-5020 | |
| (225) 647-9675 | |
| (225) 766-2226 |
| Full Name | Ms Kelly Liner Duke |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant - Medical |
| Location | 2647 S Saint Elizabeth Blvd Ste 125, Gonzales, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376522425 | NPI | - | NPPES |
| 1581666 | Medicaid | LA | |
| 200058 | Other | LA | STATE LICENSE |
| 055655 | Other | LA | CDS |
| TPA132 | Other | LA | STATE MEDICAL LIC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 200058 (Louisiana) | Primary |
| Entity Name | Our Lady of the Lake Physician Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033494943 PECOS PAC ID: 4587849781 Enrollment ID: O20120529000377 |
| Entity Name | Our Lady of the Angels Hospital Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912334533 PECOS PAC ID: 7012144322 Enrollment ID: O20140602000869 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Kelly Liner Duke, PA 5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038 Ph: (225) 526-0001 | Ms Kelly Liner Duke, PA 2647 S Saint Elizabeth Blvd Ste 125, Gonzales, LA 70737-5020 Ph: (225) 647-9675 |
Mrs. Alyssa Leger Curet, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2306 S Burnside Ave, Gonzales, LA 70737 Phone: 225-927-7546 |
Madelyn Redmond Leindecker, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1014 Saint Clair Blvd Ste 2010, Gonzales, LA 70737 Phone: 225-765-5500 Fax: 225-743-2338 |
Jessica Brianne Dettman, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1023 W Highway 30, Gonzales, LA 70737 Phone: 225-743-2366 Fax: 225-743-2369 |
Mr. David Henry Sepulveda, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2647 S Saint Elizabeth Blvd Ste 219, Gonzales, LA 70737 Phone: 225-647-8511 |
Lauren Jacob Billingsley, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1023 W Highway 30, Gonzales, LA 70737 Phone: 225-765-5500 Fax: 225-647-5342 |
Mrs. Nicole Gaudet Buuck, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1125 W Highway 30, Gonzales, LA 70737 Phone: 225-647-5098 |
Mr. Scott Kenneth Martin, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1014 Saint Clair Blvd Ste 1020, Gonzales, LA 70737 Phone: 225-743-2000 Fax: 224-743-2010 |