Letatia Vance, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

A10561 Issued in LA

Practice address

2533 Bert Kouns Industrial Loop
Shreveport, LA 71118-3158

Phone

(318) 686-3770

Fax

(318) 686-3838

NPI assigned

Jun 1, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: letatiavance@thfm-la.direct.office.nextgen.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shreveport Family Medicine Inc

  • Adult Medicine Physician
  • Shreveport, LA
  • NPI 1003975079
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1063892453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2533 BERT KOUNS INDUSTRIAL LOOP STE 106",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183158",
            "telephone_number": "318-686-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2533 BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183158",
            "telephone_number": "318-686-3770",
            "fax_number": "318-686-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANCE",
        "first_name": "LETATIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "A10561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA CERTIFICATION",
            "identifier": "1036417",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Louis Jacob Vanasselberg, MS, LPC, NCC
• Christopher Vance
• Hannah Brooks Vance, APRN
• Jessica Nicole Vance
• Johnny Vance
• John Anthony Vanchiere, MD/PHD
• Brooke Vanderberg
• Robert H. Vanderberg, MD
• Catherine Florence Vanderloos, MD
• David Theodore Vandermolen, M.D.

• Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.