NPIMap

Individual provider Active NPI

Joan Blake, MSN APRN ACNPC-AG

  • Acute Care Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1558181982
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
237621 Issued in LA
Practice address
2551 Greenwood Rd Ste 410
Shreveport, LA 71103-3989
Phone
(318) 621-2929
Fax
(318) 621-2930
NPI assigned
Oct 11, 2024
Last updated
Nov 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 237621 LA Primary

Addresses

Primary practice location

2551 Greenwood Rd Ste 410
Shreveport, LA 71103-3989

Mailing address

2551 Greenwood Rd Ste 410
Shreveport, LA 71103-3989
Phone (318) 621-2929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241209002567 LA Practitioner - Nurse Practitioner 4789110164 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Tri-State Medical ClinicGroup PAC ID 0143225128, 13 clinicians
Central Louisiana Physicians, LLCGroup PAC ID 9335598499, 55 clinicians

Practice addresses (Care Compare)

2551 Greenwood Rd
Suite 410
Shreveport, LA 71103-3989
Phone (318) 621-2929

3330 Masonic Dr
Alexandria, LA 71301-3841
Phone (318) 487-1122

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
WK Tri-State Medical Clinic CurrentSince Nov 4, 2024 Accepting new patients
Central Louisiana Physicians, LLC Nurse Practitioner CurrentSince Oct 1, 2025 Accepting new patients

Locations

3330 Masonic Dr
Alexandria, LA 71301
Phone (318) 448-6917

1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946

2551 Greenwood Rd
Ste 410
Shreveport, LA 71103
Phone (318) 621-2929

Interoperability endpoints

  • Direct secure messaging: jblake638664@christushealth.direct-ci.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1728604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1558181982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD STE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033989",
            "telephone_number": "318-621-2929",
            "fax_number": "318-621-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2551 GREENWOOD RD STE 410",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033989",
            "telephone_number": "318-621-2929",
            "fax_number": "318-621-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JOAN",
        "credential": "MSN APRN ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-11",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "237621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.