WK PEDIATRIC INTENSIVIST (NPI# 1023074549) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023074549 |
| Entity Type | Organization |
| Organization Name | WK PEDIATRIC INTENSIVIST |
| Practice Address |
2510 Bert Koun Loop Rm 4003 Shreveport LA 71118-3119 |
| Practice Telephone | 3182125665 |
| Practice Fax Number | 3182125698 |
| Mailing Telephone | 3182125665 |
| Mailing Fax Number | 3182125698 |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2018-05-09 |
| Authorized Official Name | GREG J. GAVIN (NETWORK ADMINISTRATOR) |
| Authorized Official Telephone | 3182123868 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1099091 | 05 |
| Street Address |
2510 BERT KOUN LOOP RM 4003 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71118-3119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720620784 | Wk Center for Pediatric Gastroenterology | Pediatrics | Wk Center for Pediatric Gastroenterology, 2530 Bert Kouns Industrial Loop, Ste 113, Shreveport, LA 71118 | 2019-10-11 |
| 1306302443 | Diamond Marie Willis | Case Manager/Care Coordinator | 9403 Mansfield Rd., Shreveport, LA 71118 | 2019-02-13 |
| 1194224469 | Latosa Hall | Case Manager/Care Coordinator | 9007 Letha Loop, Shreveport, LA 71118 | 2018-02-01 |
| 1902321623 | Bersheika Lashay Player | Counselor | 9403 Mansfield Road, Shreveport, LA 71118 | 2017-08-03 |
| 1518487149 | Clarke Jackson | Case Manager/Care Coordinator | 9730 Baird Rd Apt 2310, Shreveport, LA 71118 | 2017-06-24 |
| 1770010449 | Darrie'l Smith | Counselor | 2715 Mackey, Shreveport, LA 71118 | 2017-05-12 |
| 1760917041 | Delilah Wells | Case Manager/Care Coordinator | 9005 Walker Rd Apt 722, Shreveport, LA 71118 | 2017-04-25 |
| 1790229664 | We Care Transporttion Services LLC | Secured Medical Transport (VAN) | 2529 Summer Grove Dr, Shreveport, LA 71118 | 2016-12-13 |
| 1063955128 | Commanisha Smith | Social Worker | 2715 Mackey Place, Shreveport, LA 71118 | 2016-11-22 |
| 1023560802 | Yasmin Newman | Counselor | 9812 West Trails End, Shreveport, LA 71118 | 2016-10-27 |
| Find all providers in zip 71118 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992792535 | Giao N Do | Pediatrics | 2510 Bert Koun Loop, Room 4003, Shreveport, LA 71118-3119 | 2005-09-29 |
| 1215036348 | Muhammad Z Qureshi | Pediatrics | 2510 Bert Kouns Loop, Suite 4003, Shreveport, LA 71118-3119 | 2006-09-22 |
| 1992725915 | Rebecca Antee Green | Pediatrics | 1501 Kings Hwy, Department of Pediatrics, Section of Critical Care, Shreveport, LA 71103-4228 | 2006-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235366626 | Kurt D. Piggott | Pediatrics | 200 Henry Clay Ave., Acc 3308, New Orleans, LA 70118 | 2009-06-12 |
| 1659540375 | Shafqat Mahmood Cheema | Pediatrics | 6511 Arden Oaks, Alexandria, LA 71301-2863 | 2008-02-27 |
| 1932256765 | Kelechi Nneoma Iheagwara | Pediatrics | 7777 Hennessy Blvd. Suite 103, Pediatric Intensivists of La, Baton Rouge, LA 70808 | 2007-01-04 |
| 1326002841 | William Robert Pace | Pediatrics | 107 Montrose Ave, Suite D, Lafayette, LA 70503-3852 | 2006-04-13 |
| 1427570555 | Daniele Wilson | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2017-07-11 |
| 1215297957 | Ashley Loren Scheffer | Pediatrics | 1514 Jefferson Hwy, New Orleans, LA 70121 | 2012-05-28 |
| 1326304338 | Hannah Bauer | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118 | 2012-04-03 |
| 1972879781 | Rachel Lynn Hansen | Pediatrics | 200 Henry Clay Ave, New Orleans, LA 70118-5720 | 2012-03-26 |
| 1639465180 | Melissa Dawn Crowder | Pediatrics | 1514 Jefferson Hwy, New Orleans, LA 70121 | 2011-06-23 |
| 1740572270 | Sumit Datta | Pediatrics | 1514 Jefferson Hwy, New Orleans, LA 70121-2429 | 2011-05-02 |
| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71118 |
Please comment or provide details below to improve the information on WK PEDIATRIC INTENSIVIST.
| 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.