KAYCI DIAL WILSON (NPI# 1720205586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720205586 |
| Entity Type | Individual |
| Full Name | KAYCI DIAL WILSON |
| Credential | NURSE PRACTITIONER |
| Practice Address |
2727 Hearne Ave Suite 300 Shreveport LA 71103-3917 |
| Mailing Address |
Po Box 51008 Shreveport LA 71135-1008 |
| Practice Telephone | 3187989400 |
| Practice Fax Number | 3187983894 |
| Mailing Telephone | 3187989400 |
| Mailing Fax Number | 3187983894 |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2015-05-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN097383 | LA | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP05072 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 2100360 | 05 |
| Street Address |
2727 HEARNE AVE SUITE 300 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-3917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255321881 | Michael Glen Walton | Internal Medicine | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3917 | 2005-10-25 |
| 1972043511 | Wk Heart and Vascular Institute Chf Clinic | Internal Medicine | 2727 Hearne Ave, Shreveport, LA 71103-3917 | 2017-03-01 |
| 1831633510 | Kerri Lavigne | Physician Assistant | 2727 Hearne Ave, 300, Shreveport, LA 71103-3917 | 2016-12-14 |
| 1063963890 | Alex Stewart | Nurse Practitioner | 2727 Hearne Ave, Ste 300, Shreveport, LA 71103-3917 | 2016-10-17 |
| 1710366570 | James Clay Harris | Nurse Practitioner | 2727 Hearne Ave, Suite 301, Shreveport, LA 71103-3917 | 2015-05-27 |
| 1487914453 | Amy Myers Brainis | Nurse Practitioner | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3917 | 2012-05-23 |
| 1871877407 | Cassie James Miller | Physician Assistant | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3917 | 2011-09-30 |
| 1952610883 | Shannon Lea Betzing | Physician Assistant | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3931 | 2010-09-27 |
| 1134457757 | Kelli Marie Neal | Physician Assistant | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3931 | 2009-11-19 |
| 1306173638 | Amanda Mariah Savoie | Physician Assistant | 2727 Hearne Ave, Suite 300, Shreveport, LA 71103-3931 | 2009-11-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841806775 | Shelia M Reliford | Nurse Practitioner | 3928 Balcom St, Shreveport, LA 71109-5004 | 2020-09-16 |
| 1801407325 | Mariagoretti Lumnwi Niba | Nurse Practitioner | 1535 River Parkway Blvd Apt 708, Shreveport, LA 71104-1809 | 2020-08-10 |
| 1437768447 | Sheena Renaye Youngblood | Nurse Practitioner | 1453 E Bert Kouns Industrial Loop Ste 112, Shreveport, LA 71105-6810 | 2020-07-26 |
| 1285265397 | Karen Elizabeth Jordan | Nurse Practitioner | 172 Southfield Rd, Shreveport, LA 71105-3721 | 2020-01-28 |
| 1235776709 | Malene Nilaja Coleman | Nurse Practitioner | 1811 E Bert Kouns Industrial Loop Unit 210, Shreveport, LA 71105-5740 | 2019-12-04 |
| 1417504093 | Roberto Rodriquez Monsanto II | Nurse Practitioner | 3724 Baxter St, Shreveport, LA 71109-7402 | 2019-08-20 |
| 1275188757 | Sara Vergis | Nurse Practitioner | 10453 Keysburg Ct, Shreveport, LA 71106-7785 | 2019-08-02 |
| 1457912800 | Ema-chanel Johnson | Nurse Practitioner | 8219 Spring Valley Cir, Shreveport, LA 71107-8609 | 2019-06-26 |
| 1083170666 | Vanisha Faye Williams | Nurse Practitioner | 8857 Hedges Dr, Shreveport, LA 71118-2008 | 2019-02-19 |
| 1700366655 | Wendy King | Nurse Practitioner | 3060 Duncan Dr, Shreveport, LA 71119-2302 | 2018-08-20 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
Please comment or provide details below to improve the information on KAYCI DIAL WILSON.
| 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.