Provider Demographics
NPI:1871781666
Name:PENDLETON, KAREN M'LISS (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M'LISS
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6030 LINE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2062
Mailing Address - Country:US
Mailing Address - Phone:318-550-0050
Mailing Address - Fax:318-550-0053
Practice Address - Street 1:6030 LINE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2062
Practice Address - Country:US
Practice Address - Phone:318-550-0050
Practice Address - Fax:318-550-0053
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA017966207W00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1970701Medicaid
LA1970701Medicaid