Provider Demographics
NPI:1528084068
Name:KEMPER, ABBIE CREIGHTON (MD)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:CREIGHTON
Last Name:KEMPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:
Other - Last Name:CREIGHTON KEMPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-7737
Mailing Address - Fax:318-675-5666
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-7737
Practice Address - Fax:318-675-5666
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0219782085R0202X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494771Medicaid
LA5E537F600Medicare ID - Type Unspecified
LA1494771Medicaid