Active NPI
Theron Evans
- Occupational Therapy Assistant
- Shreveport, LA
National Provider Identifier
1902278641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 200290
- Practice address
- 403 E Flournoy Lucas Rd
Shreveport, LA 71115-3906 - Phone
- (318) 213-3500
- NPI assigned
- Oct 21, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 200290 | LA | Primary |
Addresses
Primary practice location
403 E Flournoy Lucas Rd
Shreveport, LA 71115-3906
Mailing address
PO Box 579
Summit, MS 39666-0579
Phone (601) 276-3900
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200290 | LA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1902278641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 579",
"city": "SUMMIT",
"state": "MS",
"postal_code": "396660579",
"telephone_number": "601-276-3900",
"fax_number": "601-276-3939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 E FLOURNOY LUCAS RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711153906",
"telephone_number": "318-213-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "THERON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-10-21",
"last_updated": "2015-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "LA",
"license": "200290",
"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 Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.