Active NPI
Carlee Gilley, DDS
- Dentist
- Shreveport, LA
National Provider Identifier
1194385203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7004
- Practice address
- 8691 Line Ave
Shreveport, LA 71106-6148 - Phone
- (328) 701-8885
- NPI assigned
- Jun 20, 2019
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7004 | LA | Primary |
Addresses
Primary practice location
8691 Line Ave
Shreveport, LA 71106-6148
Mailing address
627 Silkwood Dr
Benton, LA 71006-5000
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200404000554 | LA | Order and Referring Only - Dentist | 2466881974 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7004 | LA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560988800000",
"number": "1194385203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "627 SILKWOOD DR",
"city": "BENTON",
"state": "LA",
"postal_code": "710065000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8691 LINE AVE",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711066148",
"telephone_number": "328-701-8885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLEY",
"first_name": "CARLEE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-20",
"last_updated": "2019-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "LA",
"license": "7004",
"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 Jun 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.