Tina Faith Gentry, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

A10432 Issued in LA

Practice address

7925 Youree Dr Suite 280B
Shreveport, LA 71105-5538

Phone

(318) 212-3636

Fax

(318) 212-3649

NPI assigned

Jul 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Capitol City Family Health Center Incorporated

  dba CareSouth

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1265548614
  NPD (past)
• CVT Surgeons, Inc

  dba CVT Surgeons

  • Surgery Physician
  • Shreveport, LA
  • NPI 1427002955
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1730118365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7925 YOUREE DR SUITE 280B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 YOUREE DR SUITE 280B",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055538",
            "telephone_number": "318-212-3636",
            "fax_number": "318-212-3649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTRY",
        "first_name": "TINA",
        "middle_name": "FAITH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "A10432",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PAA10432",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1722901",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gentle Touch Mobile Phlebotomy Services, LLC
• Gentry Haughton LLC
• Gentry Haughton, LLC
• Gregory H Gentry, LAC
• Janet Gentry, MSCP
• George M Bakowski OD PC
• Altaurus George
• Demetrius George
• Gloria Joann George
• Jasmine George

• Medical Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Medical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; 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.