Kentucky R Skinner, O-PA/C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

CN88759 Issued in LA

Practice address

230 Audubon Dr
Mandeville, LA 70471

Phone

(985) 845-1501

Fax

(985) 845-1601

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224288000000",
    "number": "1225245343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 AUDUBON DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70471",
            "telephone_number": "985-845-1501",
            "fax_number": "985-845-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 AUDUBON DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70471",
            "telephone_number": "985-845-1501",
            "fax_number": "985-845-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKINNER",
        "first_name": "KENTUCKY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "O-PA/C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2008-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "CN88759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC OF ASSIST SURGEONS",
            "identifier": "CN88759",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christen Simpkins, RDMS
• Angele Marie Sirgo, LCSW-BACS, CCM
• Erica Sjunnesen, MD
• Skilled Physio
• Dawn V Skinner, MA CCC SLP
• Shawn D Skinner, PT
• Sleep Solutions of the Northshore, L.L.C.
• Sleep Solutions of the Northshore, L.L.C.
• Sleep Specialties Inc.
• Sleepworks, Inc

• Surgical Physician Assistant in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Surgical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.