Active NPI
Mary Wilson, MA
- Case Manager/Care Coordinator
- Shreveport, LA
National Provider Identifier
1881137677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 351 W 79TH St
Shreveport, LA 71106 - Phone
- (318) 688-8190
- Fax
- (318) 688-8193
- NPI assigned
- Nov 28, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
351 W 79TH St
Shreveport, LA 71106
Mailing address
171 Waters Edge Dr
Shreveport, LA 71106-7775
Phone (318) 230-4534
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527033600000",
"number": "1881137677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 WATERS EDGE DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711067775",
"telephone_number": "318-230-4534",
"fax_number": "318-688-8193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 W 79TH ST",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "71106",
"telephone_number": "318-688-8190",
"fax_number": "318-688-8193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MARY",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-28",
"last_updated": "2018-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.