WK Child Neurology

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

Legal business name

WK CHILD NEUROLOGY

Practice address

2530 Bert Kouns Industrial Loop
Suite 113
Shreveport, LA 71118-3132

Phone

(318) 212-5811

Fax

(318) 212-5844

NPI assigned

Jul 24, 2014

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) 212-8780

Specialties & licenses 1

Addresses

Member of 1

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

• Willis Knighton Medical Center, Inc.

  dba WK Extended Care Center

  • Skilled Nursing Facility
  • Shreveport, LA
  • NPI 1144267451

  Member Of

  NPD member

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

{
    "created_epoch": "1406160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406160000000",
    "number": "1639587496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-212-5811",
            "fax_number": "318-212-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 113",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183132",
            "telephone_number": "318-212-5811",
            "fax_number": "318-212-5844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK CHILD NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-24",
        "last_updated": "2014-07-24",
        "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": "318-212-8780"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• WK Center for Neurosurgery at Pierremont
• WK Center for Pediatric Gastroenterology
• WK Center for Pediatrics - South
• WK Center for Psychiatric Support
• WK Center for Womens Health and Wellness
• WK Childrens Health Specialists
• WK Community Health Clinic
• WK Ctr for Womens Health and Wellness
• WK Digestive Disease Consultants
• WK Doctors for Women

• Neurology with Special Qualifications in Child Neurology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2014; 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.