Pediatric Associates of Shreveport, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRIC ASSOCIATES OF SHREVEPORT, LLC

Practice address

1717 E Bert Kouns Industrial Loop
Shreveport, LA 71105-5561

Phone

(318) 524-1717

Fax

(318) 524-1718

NPI assigned

Jan 5, 2006

Organization subpart

No

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

Authorized official

Name

Darrell Barnett, MD

Title

Partner

Phone

(318) 524-1717

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1194703561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 E BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055561",
            "telephone_number": "318-524-1717",
            "fax_number": "318-524-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 E BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055561",
            "telephone_number": "318-524-1717",
            "fax_number": "318-524-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF SHREVEPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BARNETT",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "318-524-1717",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1949205",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirsti Nicole Peavy, PA
• Sofie M Pecchillo, MD
• Shannon Burton Peck, PHD
• Prakash Peddi, MD
• Pediatria Healthcare, LLC (Aveanna Healthcare)
• Pediatric Dental Partners, LLP
• Pediatric Gi Specialists, LLC
• Pediatric Orthotic and Prosthetic Services-Southeast, LLC
• Pediatric Providers of Louisiana (Mooretown Family Clinic)
• Frankie K Pedigo, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.