Individual provider Active NPI

Ambrosia T. Holsapple, NP

  • Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1124467733
Registry record updated Jun 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN110609 Issued in LA
Practice address
2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981
Phone
(318) 621-2929
Fax
(318) 621-2930
NPI assigned
Jun 17, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN110609 LA Primary

Addresses

Primary practice location

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981

Mailing address

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3981
Phone (318) 621-2929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130920000216 LA Practitioner - Nurse Practitioner 2668616202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Tri-State Medical ClinicGroup PAC ID 0143225128, 13 clinicians

Practice addresses (Care Compare)

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3989
Phone (318) 621-2929

Hospital & facility affiliations

  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN110609LAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
WK Tri-State Medical Clinic CurrentSince Jul 19, 2013 Accepting new patients

Locations

2551 Greenwood Rd
Ste 410
Shreveport, LA 71103
Phone (318) 621-2929

1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946

Interoperability endpoints

  • Direct secure messaging: aholsappl@direct.wkhs.com

Organizations & group practices 1

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371427200000",
    "number": "1124467733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-621-2929",
            "fax_number": "318-621-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD",
            "address_2": "SUITE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033981",
            "telephone_number": "318-621-2929",
            "fax_number": "318-621-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLSAPPLE",
        "first_name": "AMBROSIA",
        "middle_name": "T.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-17",
        "last_updated": "2013-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "RN110609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.