WHITE CLOVER, LLC (NPI# 1164893178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164893178 |
| Entity Type | Organization |
| Organization Name | WHITE CLOVER, LLC |
| Other Organization Name | WHITE CLOVER WELLNESS & RESEARCH CENTER |
| Practice Address |
460 Ashley Ridge Blvd Ste 600 Shreveport LA 71106-7235 |
| Practice Telephone | 3188614226 |
| Mailing Telephone | 3188614226 |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2016-01-26 |
| Authorized Official Name | MRS. TAMARA M SMITH (CFO) |
| Authorized Official Telephone | 3184558856 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| White Clover Wellness & Research Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104281476 | White Clover, LLC | Internal Medicine | 8835 Line Ave Ste 400, Shreveport, LA 71106-6730 | 2015-12-30 |
| Street Address |
460 ASHLEY RIDGE BLVD STE 600 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106-7235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851323810 | Russell Wayne Tynes | Internal Medicine | 460 Ashley Ridge Blvd, 500, Shreveport, LA 71106-7228 | 2006-07-07 |
| 1235442419 | Cds Ashley Ridge | Community/Behavioral Health | 460 Ashley Ridge Blvd, Suite 200, Shreveport, LA 71106-7235 | 2010-07-16 |
| 1427385368 | Bethany Cubley Crosby | Physician Assistant | 460 Ashley Ridge Blvd, Ste 600, Shreveport, LA 71106-7235 | 2009-11-13 |
| 1457531469 | Preston Phillip Peachee II | Chiropractor | 460 Ashley Ridge Blvd, Suite 200, Shreveport, LA 71106-7228 | 2007-11-07 |
| 1912029588 | Ydi Care Diagnostics Inc | Clinical Medical Laboratory | 460 Ashley Ridge Blvd, Suite 100, Shreveport, LA 71106-7228 | 2007-04-04 |
| 1902933690 | Dean A. Darr, D.c., P.a. | Chiropractor | 460 Ashley Ridge Blvd, Suite 200, Shreveport, LA 71106-7228 | 2007-02-28 |
| 1568528487 | Charles Stewart Williams | Dentist | 460 Ashley Ridge Blvd, Suite 600, Shreveport, LA 71106-7228 | 2006-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| Find all providers in zip 71106 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740829217 | Bno Surgical Consultants, LLC | Physician Assistant | 303 Captain Hm Shreve Blvd, Shreveport, LA 71115 | 2020-01-02 |
| 1497394076 | Midday Surgical Consultants, LLC | Physician Assistant | 550 Linden St, Shreveport, LA 71104-4426 | 2019-12-31 |
| 1225677800 | Geaux Surgical Consultants, LLC | Physician Assistant | 370 Gallier Pl, Shreveport, LA 71106-8377 | 2019-12-31 |
| 1962041541 | Ace Surgical Consultants, LLC | Physician Assistant | 11045 Gabriels Path, Shreveport, LA 71106-7791 | 2019-12-31 |
| 1013499763 | Kristi Harrison Gaspard | Physician Assistant | 2508 Bert Koun Loop Ste 106, Shreveport, LA 71118-3175 | 2018-08-29 |
| 1295216125 | Heather White | Physician Assistant | 745 Olive St Ste 200, Shreveport, LA 71104-2246 | 2018-08-28 |
| 1285143669 | Kara Forbis | Physician Assistant | 2600 Kings Hwy Ste 420, Shreveport, LA 71103-3950 | 2017-09-28 |
| 1144748195 | Catherine Murphy Rogers | Physician Assistant | 2727 Hearne Ave Ste 300, Shreveport, LA 71103-3918 | 2017-08-30 |
| 1972955474 | Robin Egan | Physician Assistant | 1811 E Bert Koun Loop Ste 200, Shreveport, LA 71105-5766 | 2016-07-07 |
| 1457733198 | Brfhh Shreveport LLC | Physician Assistant | 1541 Kings Highway, Shreveport, LA 71103-4228 | 2015-06-18 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
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| 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.