WK Ark-la-Tex Neonatology

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

Legal business name

WK ARK-LA-TEX NEONATOLOGY

Practice address

2510 Bert Kouns Loop
Room 215
Shreveport, LA 71118-3119

Phone

(318) 212-5970

NPI assigned

Jul 11, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Greg J Gavin

Title

Network/Administrator

Phone

(318) 212-4571

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anna Elise Navarro, PA-C

  • Medical Physician Assistant
  • Shreveport, LA
  • NPI 1780290338
  NPD (past)
• Lea Bonifacio Penales, MD

  • Neonatal-Perinatal Medicine Physician
  • Shreveport, LA
  • NPI 1003809211
  NPD (past)
• Samantha Walters Smith

  • Neonatal Nurse Practitioner
  • Shreveport, LA
  • NPI 1487529277
  NPD (past)
• Gerald Brent Whitton, MD

  • Neonatal-Perinatal Medicine Physician
  • Shreveport, LA
  • NPI 1285666487
  NPD (past)
• Scott A Walls, M.D.

  • Pediatrics Physician
  • Atlanta, TX
  • NPI 1720242431

  Neonatal-Perinatal Medicine

  NPD (past)

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339459200000",
    "number": "1780848580",
    "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": "318-212-8946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 BERT KOUNS LOOP",
            "address_2": "ROOM 215",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183119",
            "telephone_number": "318-212-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK ARK-LA-TEX NEONATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-11",
        "last_updated": "2012-06-12",
        "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": "318-212-4571",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1816671",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neonatal-Perinatal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Neonatal-Perinatal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; 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.