WK Kinnebrew and Johnson Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WK KINNEBREW AND JOHNSON CLINIC

Practice address

2508 Bert Kouns Loop Ste 102
Shreveport, LA 71118-3175

Phone

(318) 688-6630

Fax

(318) 688-6014

NPI assigned

Oct 24, 2007

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) 212-4232

Specialties & licenses 1

Addresses

Other identifiers 1

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

Locations

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339113600000",
    "number": "1902085186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP STE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183175",
            "telephone_number": "318-688-6630",
            "fax_number": "318-688-6014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP STE 102",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183175",
            "telephone_number": "318-688-6630",
            "fax_number": "318-688-6014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WK KINNEBREW AND JOHNSON CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-24",
        "last_updated": "2012-06-08",
        "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": "318-212-4232"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021652",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• WK Gynecologic Oncology Clinic
• WK Heart and Vascular Institute CHF Clinic
• WK Hematology Oncology Associates
• WK Hyperbaric & Wound Care Center
• WK Internal Medicine Specialists
• WK Mid South Orthopedics
• WK Minimally Invasive Surgery Center
• WK Moller Cassiere Clinic
• WK Neurology Consultants
• WK Neurosurgical Associates

• Family Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.