DR. SHANNON BURTON PECK (NPI# 1902963929) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902963929 |
| Entity Type | Individual |
| Full Name | DR. SHANNON BURTON PECK |
| Credential | PHD |
| Practice Address |
510 E Stoner Ave Shreveport LA 71101-4243 |
| Practice Telephone | 3189904957 |
| Mailing Telephone | 3189904957 |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2013-08-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
32882 | TX | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 177186701 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346531928 | Shannon Peck | Physician Assistant | 1159 E 200 N, #250, American Fork, UT 84003-2022 | 2011-04-29 |
| 1083819650 | Shannon R Peck | Radiology | 1210 W 18th St, Ste Ll03, Sioux Falls, SD 57104-4647 | 2007-06-15 |
| 1457466922 | Shannon Lea Peck | Counselor | 5410 Fredericksburg Road, Suite 111, San Antonio, TX 78229-3539 | 2006-08-21 |
| 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 | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518267889 | Jeanne Street, Phd, Appc | Psychologist | 610 Herndon Ave., Shreveport, LA 71101 | 2010-11-02 |
| 1508055187 | Wendi Leigh Johnson Laborde | Psychologist | 2620 Centenary Blvd Ste 120, Shreveport, LA 71104-3349 | 2007-10-18 |
| 1548452832 | Gerald Kenneth Baker | Psychologist | 702 Kings Hwy, Shreveport, LA 71104-4332 | 2007-08-10 |
| 1033273107 | Jeanne Street | Psychologist | 610 Herndon Ave, Shreveport, LA 71101 | 2006-12-21 |
| 1700983251 | Milton Rhea | Psychologist | 510 E. Stoner Ave, Shreveport, LA 71101 | 2006-09-19 |
| 1730168139 | Alan Lee Rogers | Psychologist | 257 Atkins Ave, Shreveport, LA 71104-4537 | 2006-01-13 |
| 1316577141 | Jennifer L Russell, Psychologist, LLC | Psychologist | 3341 Youree Dr Ste 20a, Shreveport, LA 71105-2149 | 2020-01-21 |
| 1215309620 | Sarah Watts Drummond | Psychologist | 707 Southfield Rd, Shreveport, LA 71106-2219 | 2015-10-24 |
| 1558789701 | Mark Garcia | Psychologist | 2620 Centenary Blvd, Bldg. #3, Suite 207, Shreveport, LA 71104-3356 | 2014-04-04 |
| 1972947034 | Steven D Abney | Psychologist | 1811 E Bert Kouns Industrial Loop, Suite 300, Shreveport, LA 71105-5740 | 2013-04-19 |
| 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.