Active NPI
Mark Knackstedt
- Otolaryngology Physician
- Shreveport, LA
National Provider Identifier
1285203521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 352615
- Practice address
- 2530 Bert Kouns Industrial Loop Ste 112
Shreveport, LA 71118-3153 - Phone
- (318) 212-3960
- Fax
- (318) 212-3907
- NPI assigned
- Jun 22, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 352615 | LA | Primary |
Addresses
Primary practice location
2530 Bert Kouns Industrial Loop Ste 112
Shreveport, LA 71118-3153
Mailing address
2530 Bert Kouns Industrial Loop Ste 112
Shreveport, LA 71118-3153
Phone (318) 212-3960
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783641600000",
"number": "1285203521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 BERT KOUNS INDUSTRIAL LOOP STE 112",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711183153",
"telephone_number": "318-212-3960",
"fax_number": "318-212-3907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2530 BERT KOUNS INDUSTRIAL LOOP STE 112",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711183153",
"telephone_number": "318-212-3960",
"fax_number": "318-212-3907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNACKSTEDT",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-22",
"last_updated": "2026-07-10",
"certification_date": "2026-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "LA",
"license": "352615",
"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 Jul 10, 2026; 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.