Active NPI
Coreen Wilson
- Transportation Broker
- Shreveport, LA
National Provider Identifier
1114502093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Transportation Broker
- Practice address
- 4401 Wildwood Dr
Shreveport, LA 71119-8611 - Phone
- (318) 210-5187
- NPI assigned
- Mar 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Transportation Broker | 347E00000X | Primary |
Addresses
Primary practice location
4401 Wildwood Dr
Shreveport, LA 71119-8611
Mailing address
4401 Wildwood Dr
Shreveport, LA 71119-8611
Phone (318) 210-5187
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Coreenwilson1987@icloud.com | Direct |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615507200000",
"number": "1114502093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 WILDWOOD DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711198611",
"telephone_number": "318-210-5187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 WILDWOOD DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711198611",
"telephone_number": "318-210-5187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "COREEN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-12",
"last_updated": "2021-03-12",
"certification_date": "2021-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "347E00000X",
"taxonomy_group": "",
"desc": "Transportation Broker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Coreenwilson1987@icloud.com",
"affiliation": "N",
"endpointDescription": "personal email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "4401 Wildwood Dr",
"city": "Shreveport",
"state": "LA",
"country_code": "US",
"postal_code": "711198611",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.