Evetta Lavern Borden, DPM
Individual provider Active NPI Foot Surgery Podiatrist · Shreveport, LA
NPI 1215946702 · NPPES record last updated Sep 1, 2023
Key facts
- NPI
- 1215946702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot Surgery Podiatrist 213ES0131X
- License
- POD000770 (GA)
- Practice address
- 510 E Stoner Ave
Shreveport, LA 71101-4243 - Phone
- (912) 977-0584
- NPI assigned
- Aug 5, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190315001909 | GA | Order and Referring Only - Podiatry |
6608804059 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 770 | GA | MD | Addiction (Substance Use Disorder) Counselor |
| POD000770 | GA | MD | Foot Surgery Podiatrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | POD000770 | GA | Yes |
Addresses
Primary practice location
510 E Stoner Ave
Shreveport, LA 71101-4243
Mailing address
614 Westmoreland Dr
Hinesville, GA 31313-4419
Phone (912) 977-0584
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00719804B | Medicaid | GA |
Other providers in Shreveport, LA
- Marjorie Letarde Booty
- Sukhmani Boparai
- Austin Bordelon
- Barbara Janelle Bordelon
- Randy Gerard Bordelon
- Thomas W Borders
- Evelyn Bordovsky
- Allison Borel
- Patti F. Bornaman
- Alan John Borne
All providers in Shreveport, LA · Foot Surgery Podiatrist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.