WK TOTS TO TEENS PEDIATRIC CENTER (NPI# 1063769255) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063769255 |
| Entity Type | Organization |
| Organization Name | WK TOTS TO TEENS PEDIATRIC CENTER |
| Practice Address |
845 Olive St Suite A Shreveport LA 71104-2141 |
| Practice Telephone | 3182264892 |
| Practice Fax Number | 3182274927 |
| Mailing Telephone | 3182264892 |
| Mailing Fax Number | 3182274927 |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |
| Authorized Official Name | GREG J GAVIN (NETWORK ADMINISTRATOR) |
| Authorized Official Telephone | 3182124232 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Street Address |
845 OLIVE ST SUITE A |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71104-2141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548243793 | Donald I Posner | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2005-11-22 |
| 1306100029 | Ramona Dsouza | Pediatrics | 845 Olive St, Suite A, Shreveport, LA 71104-2141 | 2012-06-27 |
| 1427291863 | Stacey D Sparks | Pediatrics | 845 Olive St, Shreveport, LA 71104-2141 | 2009-04-15 |
| 1932310687 | Sheyenne W Carper | Pediatrics | 845 Olive St, Suite A, Shreveport, LA 71104-2141 | 2007-05-24 |
| 1851358998 | Jason Jude Romero | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2006-05-01 |
| 1306829916 | David J Clemons | Dermatology | 845 Olive St, Shreveport, LA 71104-2101 | 2005-11-29 |
| 1861475691 | Jack S Resneck | Dermatology | 845 Olive St, Shreveport, LA 71104 | 2005-11-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326582263 | Dana Jackson | Counselor | 2425 Youree Drive, Shreveport, LA 71104 | 2016-12-12 |
| 1154772929 | Belena Cawthorne | Case Manager/Care Coordinator | 2040 Southern Ave, Shreveport, LA 71104 | 2016-06-23 |
| 1437505286 | Courtney Espenan | Counselor | 3825 Gilbert Dr Ste 124, Shreveport, LA 71104 | 2016-05-11 |
| 1215390497 | Joshua Mitchell | Counselor | 1106 Dalzell Street, Shreveport, LA 71104 | 2016-04-04 |
| 1699135426 | Amy Lutricia Krohn | Counselor | 1041 Dalzell St, Shreveport, LA 71104 | 2016-03-07 |
| 1225497779 | Annie Redding II | Counselor | 2525 Youree Dr Suite 110, Shreveport, LA 71104 | 2016-02-12 |
| 1891152328 | Council On Alcoholism and Drug Abuse of Northwest Louisiana | Community/Behavioral Health | 2000 Fairfield Ave, Shreveport, LA 71104 | 2016-01-28 |
| 1922465731 | Marteze Singleton | Case Manager/Care Coordinator | 2525 Youree Dr Ste 10, Shreveport, LA 71104 | 2016-01-25 |
| 1891160297 | Damara Mora | Counselor | 2620 Centenary Blvd Bldg3 Ste 312, Shreveport, LA 71104 | 2015-12-10 |
| 1962876250 | Chastity Shermaine Graham | Counselor | 2620 Centenary Blvd Ste 312, Shreveport, LA 71104 | 2015-11-24 |
| Find all providers in zip 71104 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619311438 | Amanda Vice Haynie | Pediatrics | 2225 Line Avenue, Mid City Pediatrics, Shreveport, LA 71104 | 2013-04-23 |
| 1487913976 | Greg M Oji | Pediatrics | 2508 Bert Kouns Industrial Loop Ste 320, Shreveport, LA 71118-3154 | 2012-05-03 |
| 1497011001 | Tamara Lynn Moore | Pediatrics | 1811 E Bert Kouns Industrial Loop Ste 140, Shreveport, LA 71105-5741 | 2012-04-09 |
| 1316228984 | Choice Pediatrics, LLC | Pediatrics | 6930 Fern Ave, Suite 150, Shreveport, LA 71105-4100 | 2011-09-08 |
| 1598077323 | Virginia Homza Carter | Pediatrics | 909 Olive St, Shreveport, LA 71104 | 2010-07-09 |
| 1891938239 | Nicolette Humphries | Pediatrics | 2518 Bert Kouns Ind. Loop, Shreveport, LA 71118-3112 | 2009-04-15 |
| 1407042435 | Hester Suh | Pediatrics | 2709 Mackey Ln, Shreveport, LA 71118-2556 | 2007-09-24 |
| 1639203367 | Suyah M Loud | Pediatrics | 4140 Hollywood Ave, Suite B-2, Shreveport, LA 71109-7818 | 2007-03-15 |
| 1891833869 | Holliway Medical Clinic LLC | Pediatrics | 3824 Hearne Ave, Shreveport, LA 71103 | 2007-02-02 |
| 1134295520 | D Gene Mack Jr Md and Willis-knighton Medical Center | Pediatrics | 1799 E Bert Kouns Industrial Loop, Shreveport, LA 71105-5561 | 2006-11-28 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71104 |
Please comment or provide details below to improve the information on WK TOTS TO TEENS PEDIATRIC CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.