Provider Demographics
NPI:1174959779
Name:PILGREEN, KENDALL THOMAS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:THOMAS
Last Name:PILGREEN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1202 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3910
Mailing Address - Country:US
Mailing Address - Phone:318-212-8574
Mailing Address - Fax:318-212-4153
Practice Address - Street 1:1111 LINE AVE 3RD FLOOR
Practice Address - Street 2:TOWER 2
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-716-4610
Practice Address - Fax:318-716-4690
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
LAPA.200647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant