WK Center for Psychiatric Support

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

WK CENTER FOR PSYCHIATRIC SUPPORT

Practice address

1111 Line Ave 3Rd Floor Tower 2
Shreveport, LA 71101-3981

Phone

(318) 716-4610

Fax

(318) 716-4690

NPI assigned

May 5, 2010

Organization subpart

No

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

Authorized official

Name

Greg J. Gavin

Title

Network Administrator

Phone

(318) 212-4232

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Willis Knighton Medical Center, Inc.

  dba WK Renal Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Shreveport, LA
  • NPI 1003020579

  Member Of

  NPD member

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jason Broussard, D.O.

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1376744771
  Medicare reassignment Care Compare group NPD
• Devanshi K. Jani, MD

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1770794083
  Medicare reassignment Care Compare group NPD
• Matthew Scott Menard, MD

  • Psychiatry Physician
  • Shreveport, LA
  • NPI 1407148992
  Medicare reassignment Care Compare group NPD
• Claudia Orellana, M.D.

  • Psychiatry Physician
  • Bossier City, LA
  • NPI 1417167842
  Medicare reassignment Care Compare group NPD
• Chandra Walker-Target, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Shreveport, LA
  • NPI 1871214064

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Arien McKenzie Ward, PSYD

  • Clinical Psychologist
  • Bossier City, LA
  • NPI 1578702643
  Medicare reassignment Care Compare group NPD
• Anna Michele Wren, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Shreveport, LA
  • NPI 1033973391
  Medicare reassignment Care Compare group NPD
• Kirsti Nicole Peavy, PA

  • Medical Physician Assistant
  • Shreveport, LA
  • NPI 1417284373
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1273017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487289600000",
    "number": "1609194356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 LINE AVE 3RD FLOOR TOWER 2",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013981",
            "telephone_number": "318-716-4610",
            "fax_number": "318-716-4690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 LINE AVE 3RD FLOOR TOWER 2",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013981",
            "telephone_number": "318-716-4610",
            "fax_number": "318-716-4690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK CENTER FOR PSYCHIATRIC SUPPORT",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-05",
        "last_updated": "2017-02-17",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Care for Kids Clinic
• WK Center for Endocrinology and Diabetes
• WK Center for Neurosurgery at Pierremont
• WK Center for Pediatric Gastroenterology
• WK Center for Pediatrics - South
• WK Center for Womens Health and Wellness
• WK Child Neurology
• WK Childrens Health Specialists
• WK Community Health Clinic
• WK Ctr for Womens Health and Wellness

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.