GENESIS NEPHROLOGY, LLC (NPI# 1285881508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285881508 |
| Entity Type | Organization |
| Organization Name | GENESIS NEPHROLOGY, LLC |
| Practice Address |
1560 Irving Pl Shreveport LA 71101-4604 |
| Practice Telephone | 3182212707 |
| Practice Fax Number | 3182212709 |
| Mailing Telephone | 3182212707 |
| Mailing Fax Number | 3182212709 |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |
| Authorized Official Name | DR. MARISA TURNER JOHNSON (PHYSICIAN) |
| Authorized Official Telephone | 3182212707 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
023908 | LA | Allopathic & Osteopathic Physicians |
| Street Address |
1560 IRVING PL |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245441005 | Fred Spencer Willis Sr. | Family Medicine | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2007-05-24 |
| 1669028692 | Elizabeth Chesne | Physician Assistant | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2019-08-15 |
| 1972058170 | Diabetes Assessment and Management Center of Shreveport LLC | Dietitian, Registered | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2016-08-18 |
| 1417349101 | Barbin Lewis | Dietitian, Registered | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2015-03-04 |
| 1073950028 | Diabetes Assessment and Management Center of Shreveport, LLC | Clinic/Center | 1560 Irving Pl, Suite 501, Shreveport, LA 71101-4604 | 2013-05-31 |
| 1205047578 | William Lee Gibson Jr. | Family Medicine | 1560 Irving Pl, Shreveport, LA 71101-4604 | 2007-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255988630 | Renee Jewitt | Case Manager/Care Coordinator | 1513 Line Avenue, Suite 225, Shreveport, LA 71101 | 2019-08-21 |
| 1942770094 | Bessie Larry | Case Manager/Care Coordinator | 1513 Line Av, 222, Shreveport, LA 71101 | 2018-12-03 |
| 1750875944 | Jarvis Decarleonne Larry | Community Health Worker | 1513 Line Ave # 222, Shreveport, LA 71101 | 2018-06-20 |
| 1871083485 | Kimberly B. Mcclelland, Lcsw | Counselor | 820 Jordan St. Ste 510w, Shreveport, LA 71101 | 2018-05-18 |
| 1982106456 | Hudson Amc LLC | Internal Medicine | 1800 Irving Place, Shreveport, LA 71101 | 2018-03-01 |
| 1528572955 | Spencer Ron Floyd | Counselor | 1717 Marshall Street, Shreveport, LA 71101 | 2017-11-21 |
| 1578088076 | Brittany Morris | Case Manager/Care Coordinator | 1835 Spring Street Annex Building, Shreveport, LA 71101 | 2017-08-07 |
| 1275058794 | Diane Williams | Case Manager/Care Coordinator | 217 Jones St Apt 510, Shreveport, LA 71101 | 2017-08-04 |
| 1386195972 | Jakeya Woodbury | Counselor | 453 Stoner Ave, Shreveport, LA 71101 | 2016-10-18 |
| 1922459643 | Arlene Huling | Counselor | 449 Egan Street, Shreveport, LA 71101 | 2016-06-23 |
| Find all providers in zip 71101 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| 1629187422 | John Stephen Kilpatrick | Internal Medicine | 745 Olive St Ste 207, Shreveport, LA 71104-2250 | 2006-08-29 |
| 1831184407 | Marwan Kaskas | Internal Medicine | 2501 Greenwood Rd, Shreveport, LA 71103-3905 | 2005-09-20 |
| 1710972559 | Arnold E Barz | Internal Medicine | 1800 Buckner St, Suite C120, Shreveport, LA 71101-4440 | 2005-09-19 |
| 1447242680 | Henry Edward Wood Jr. | Internal Medicine | 745 Olive St, Ste 200, Shreveport, LA 71104-2246 | 2005-08-15 |
| 1083615520 | Marisa Johnson | Internal Medicine | 1303 Line Ave, Ste 400, Shreveport, LA 71101-4628 | 2005-08-09 |
| 1194292516 | Southern Kidney Associates Pllc | Internal Medicine | 1815 E 70th St, Shreveport, LA 71105-5301 | 2018-10-24 |
| 1356713440 | Delta Nephrology LLC | Internal Medicine | 745 Olive St, Suite 200, Shreveport, LA 71104-2246 | 2015-10-28 |
| 1386013670 | John S Kilpatrick Md A Professional Medical Corporation | Internal Medicine | 745 Olive St Ste 207, Shreveport, LA 71104-2250 | 2015-09-17 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
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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.