Bobbi S Edstrom, PA
Individual provider Active NPI Physician Assistant · Kinder, LA
NPI 1447420328 · NPPES record last updated Jul 31, 2013
Key facts
- NPI
- 1447420328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA200640 (LA)
- Practice address
- 108 6TH Ave
Kinder, LA 70648-3187 - Phone
- (337) 738-9494
- NPI assigned
- Mar 6, 2008
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150408000657 | LA | Order and Referring Only - Physician Assistant | 5799003547 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9101513 | FL | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9101513 | FL | |
| Physician Assistant | 363A00000X | PA200640 | LA | Yes |
Addresses
Primary practice location
108 6TH Ave
Kinder, LA 70648-3187
Mailing address
108 6TH Ave
Kinder, LA 70648-3187
Phone (337) 738-9494
Other providers in Kinder, LA
- Matthew Ross Courville
- Coushatta Tribe of Louisiana
- Coushatta Tribe of Louisiana
- Jason Scott Doucet
- Edge Medical Services
- Michael Patrick England
- Savannah V Frith
- Tammy Cline Gillett
- Cyndel Rae Grainger
- Morgan Harmon
All providers in Kinder, LA · Physician Assistant in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.