Terry Wayne Kendrick, MD
Individual provider Active NPI Pediatrics Physician · Shreveport, LA
NPI 1821076274 · NPPES record last updated Jan 24, 2017
Key facts
- NPI
- 1821076274
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD.017838 (LA)
- Practice address
- 1549 E 70TH St
Ste 300
Shreveport, LA 71105-5053 - Phone
- (318) 681-4896
- Fax
- (318) 681-4897
- NPI assigned
- Jan 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070910000270 | LA | Practitioner - Pediatric Medicine | 0840383758 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 017838 | LA | MD | Pediatrics Physician |
| MD.017838 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C H Wilkinson Physician Network | Current |
Accepting new patients | |
| C H Wilkinson Physician Network | Pediatrics | Current |
Accepting new patients |
Locations
1 Saint Mary Pl
Shreveport, LA 71101
Phone (318) 681-4500
1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138
1549 E 70th St
Ste 300
Shreveport, LA 71105
Phone (318) 300-3898
919 Hidden Rdg
Irving, TX 75038
Interoperability endpoints
- https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 017838 | LA | |
| Pediatrics Physician | 208000000X | MD.017838 | LA | Yes |
Addresses
Primary practice location
1549 E 70TH St
Ste 300
Shreveport, LA 71105-5053
Mailing address
919 Hidden RDG
Irving, TX 75038-3813
Phone (469) 282-2711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1371793 | Medicaid | LA |
Other providers in Shreveport, LA
- Cassandra Anne Kemmerer
- Susan Elizabeth Kemp
- Candace Capelan Kemper
- Ken Stanley MD and Willis-Knighton Medical Center
- Jazzelyn Kendrick
- Aliyah Kennedy
- Felicia Hullaby Kennedy
- Jacqueline Kennedy
- Jeffrey Brant Kennedy
- Kathryn Kay Kennedy
All providers in Shreveport, LA · Pediatrics Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.