WK Louisiana Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WK LOUISIANA FAMILY PRACTICE

Practice address

2300 Hospital Dr
Suite 200
Bossier City, LA 71111-2394

Phone

(318) 212-7830

Fax

(318) 212-7835

NPI assigned

Jun 11, 2006

Organization subpart

No

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

Authorized official

Name

Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-8780

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kaitlyn Bland Rogers, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1427792969
  Medicare reassignment Care Compare group NPD
• Taylor Curry Bradford, FNP

  • Family Nurse Practitioner
  • Bossier City, LA
  • NPI 1790303352
  Medicare reassignment Care Compare group NPD
• John Philip Harris, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1437234903
  Medicare reassignment Care Compare group NPD
• Scott Louis Mighell, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1093759854
  Medicare reassignment Care Compare group NPD
• Daniel L. Payne, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1073557542
  Medicare reassignment Care Compare group NPD
• Sanjaykumar B Shah, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1740226505
  Medicare reassignment Care Compare group NPD
• Melanie Smith, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1659317410
  Medicare reassignment Care Compare group NPD
• Robert Charles Smith II, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1972863231
  Medicare reassignment Care Compare group NPD
• Ted Broox Warren, MD

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1306878509
  Medicare reassignment Care Compare group NPD
• Jennifer Wilkinson, PA-C

  • Physician Assistant
  • Bossier City, LA
  • NPI 1568408326
  Medicare reassignment

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1164464889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "SUITE 200",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-212-7830",
            "fax_number": "318-212-7835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR",
            "address_2": "SUITE 200",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112394",
            "telephone_number": "318-212-7830",
            "fax_number": "318-212-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK LOUISIANA FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2012-06-08",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-8780"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1452858",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Ctr for Ear Nose and Throat Disorders
• WK Dermatology Clinic
• WK Endocrine Specialists
• WK Haughton Medical Group
• WK Internal Medicine and Pediatric Specialists
• WK Neurology Clinic
• WK North Bossier ENT
• WK Precision Neurosurgery
• WK Preferred Pediatrics
• WK Premier Pediatrics

• Family Medicine Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.