KELLY WHITE RUSSO (NPI# 1770805830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770805830 |
| Entity Type | Individual |
| Full Name | KELLY WHITE RUSSO |
| Credential | RPH |
| Practice Address |
510 E Stoner Ave Shreveport LA 71101-4243 |
| Mailing Address |
4423 Creswell Ave Shreveport LA 71106-1631 |
| Practice Telephone | 3182218411 |
| Enumeration Date | 2010-02-17 |
| Last Update Date | 2010-02-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 16746 | LA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467466656 | Kelly Sipe Russo | Internal Medicine | 1 Harry S Truman Pkwy, Ms 3102, Annapolis, MD 21401-7037 | 2006-07-27 |
| 1487218012 | Kelly Russo | Speech-Language Pathologist | 9047 W Greenfield Ave, West Allis, WI 53214-2800 | 2019-04-29 |
| 1073822409 | Kelly Lynn Russo | Speech-Language Pathologist | 51 St Johns Parkside, Buffalo, NY 14210-2515 | 2010-10-04 |
| 1326362815 | Kelly T Russo | Pharmacist | 11 E Main St, Marcellus, NY 13108-1224 | 2010-03-26 |
| 1265664734 | Kelly L Russo | Psychologist | 1767 Village Park Dr, Orangeburg, SC 29118-2475 | 2009-08-18 |
| 1326115841 | Kelly A Russo | Physical Therapist | 414 Paoli Pike, Malvern, PA 19355-3311 | 2006-11-29 |
| Street Address |
510 E STONER AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71101-4243 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427056456 | Philip Assaad Haddad | Internal Medicine | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2005-07-13 |
| 1124627344 | Tiffany Knesha Williams | Social Worker | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-10-19 |
| 1255938882 | Michael Phillip Parrott | Registered Nurse | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-10-06 |
| 1013524222 | Brittany Hawkins | Dietitian, Registered | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-09-30 |
| 1598376873 | Martha Stevens | Dietitian, Registered | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-08-11 |
| 1609491844 | Kenneth Charles Sweatman Jr. | Registered Nurse | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-06-13 |
| 1528682663 | Ashley Nicole Denbrock | Registered Nurse | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-06-04 |
| 1154941227 | Angel Escobedo | Registered Nurse | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2020-04-19 |
| 1679116784 | Allisyn Steele | Registered Nurse | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2019-10-21 |
| 1811530926 | Comis Waddell | Registered Nurse | 510 E Stoner Ave, Shreveport, LA 71101-4243 | 2019-10-21 |
| Find all providers in the same location | ||||
| 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 | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982211397 | Bradford Louis Morgan | Pharmacist | 9084 Ferry Creek Dr, Shreveport, LA 71106-8404 | 2020-09-29 |
| 1306453451 | Benjamin Allbritton | Pharmacist | 1333 Coates Bluff Dr Apt 1324, Shreveport, LA 71104-2823 | 2020-09-23 |
| 1760031652 | Cecelia Vergo | Pharmacist | 388 Bert Kouns Industrial Loop, Shreveport, LA 71106-8123 | 2019-09-04 |
| 1700431244 | Jennifer S Boudreaux | Pharmacist | 1410 Kings Hwy, Shreveport, LA 71103-4227 | 2019-08-01 |
| 1932688702 | Cortez Davis | Pharmacist | 6000 W 70th St Apt 1107, Shreveport, LA 71129-2530 | 2018-08-12 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1407225410 | Jeff Jones | Pharmacist | 5907 Old Mooringsport Rd, Shreveport, LA 71107-2023 | 2015-09-20 |
| 1063816353 | Rita Saye | Pharmacist | 319 Albany Ave, Shreveport, LA 71105-2001 | 2014-10-15 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71101 |
Please comment or provide details below to improve the information on KELLY WHITE RUSSO.
| 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.