SOUTH SHREVEPORT FAMILY MEDICINE LLC NPI 1013217595

NPI Information

NPI: 1013217595
Provider Name: SOUTH SHREVEPORT FAMILY MEDICINE, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
8660 FERN AVE STE 105
SHREVEPORT, LA
ZIP 71105
Phone: (318) 797-0009
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SOUTH SHREVEPORT FAMILY MEDICINE, LLC is a family nurse practitioner in Shreveport, LA. SOUTH SHREVEPORT FAMILY MEDICINE, LLC NPI is 1013217595. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

8660 FERN AVE STE 105
SHREVEPORT, LA
ZIP 71105-657
Phone: (318) 797-0009
Fax: (318) 797-0092

The provider's authorized official is Jon Charles Barnes .
The authorized official title is Fnp and has the following contact phone number (318) 349-6728.

The enumeration date for this NPI number is 10/29/2010 and was last updated on 10/5/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1131831	MEDICAID	LOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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