Mark Alan Cogburn, LPC,LMFT

Primary specialty

Clinical Nurse SpecialistTaxonomy code 364S00000X

License

AP06313 Issued in LA

Practice address

1541 Kings Hwy
Shreveport, LA 71103

Phone

(318) 626-0000

NPI assigned

Jan 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• WK Advanced Surgery Center

  • Surgery Physician
  • Shreveport, LA
  • NPI 1609110634
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1952458713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1541 KINGS HWY",
            "address_2": "ATTN: PAYOR CREDENTIALING",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-626-0287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-626-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Kings Hwy",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711034228",
            "country_code": "US",
            "telephone_number": "318-675-4881",
            "fax_number": "318-675-5069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COGBURN",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "LPC,LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "1595",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "LA",
            "license": "177",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "LA",
            "license": "AP06313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Poynter Cockrell, M.D.
• Nguyen Tran Cockrell, DNAP, CRNA
• Robin Leigh Cockrell, M.D.
• Cody Tingle MD LLC
• Kirk W. Cofran, MD
• Tammy Lynn Coggins, LMT #LA4024-01
• Raymond A. Coghlan, MD
• Cognitive Development Consultants, Inc. (Family Life Development Center)
• Juanita Coke, M.D
• Brittney Marie Coker, MS

• Clinical Nurse Specialist in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Clinical Nurse Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; 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.