Provider Demographics
NPI:1144504796
Name:CLAWSON, REBECCA ESKEW (PA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ESKEW
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:ESKEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 33932
Mailing Address - Street 2:SAHP PA PROGRAM
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71130-3932
Mailing Address - Country:US
Mailing Address - Phone:318-813-2927
Mailing Address - Fax:318-813-2915
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:SAHP PA PROGRAM
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-813-2927
Practice Address - Fax:318-813-2915
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200481363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2182960Medicaid
LA57720PF79Medicare PIN