Active NPI
Mary J. Davis
- Social Worker
- Shreveport, LA
National Provider Identifier
1003023995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 5639
- Practice address
- Overton Brooks VA Medical Center
510 E. Stoner Avenue
Shreveport, LA 71101-4295 - Phone
- (318) 221-8411
- Fax
- (318) 429-5721
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 5639 | LA | Primary |
Addresses
Primary practice location
Overton Brooks VA Medical Center
510 E. Stoner Avenue
Shreveport, LA 71101-4295
Mailing address
700 Arlington St
Ruston, LA 71270-4952
Phone (318) 255-6017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5639 | LA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003023995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 ARLINGTON ST",
"city": "RUSTON",
"state": "LA",
"postal_code": "712704952",
"telephone_number": "318-255-6017",
"fax_number": "318-429-5721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "OVERTON BROOKS VA MEDICAL CENTER",
"address_2": "510 E. STONER AVENUE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711014295",
"telephone_number": "318-221-8411",
"fax_number": "318-429-5721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MARY",
"middle_name": "J.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "LA",
"license": "5639",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.