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NPI Code Detail

MEDICARE: KIMBERLY BURNS MD & WILLIS-KNIGHTON MEDICAL CENTER

MEDICARE: KIMBERLY BURNS MD & WILLIS-KNIGHTON MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1053347658
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIMBERLY BURNS MD & WILLIS-KNIGHTON MEDICAL CENTER
Provider Business Mailing Address
First Line : 2518 BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-3112
Country : US
Telephone Number : 318-212-5437
Fax Number : 318-212-5825
Provider Business Practice Location Address
First Line : 2518 BERT KOUNS LOOP
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-3112
Country : US
Telephone Number : 318-212-5437
Fax Number : 318-212-5825
Authorized Official
Title or Position : NETWORK ADMINISTRATOR
Name : GREG J. GAVIN
Credential :
Telephone Number : 318-212-5437
Provider Enumeration Date : 06/24/2006
Last Update Date : 08/22/2020

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Directions to “KIMBERLY BURNS MD & WILLIS-KNIGHTON MEDICAL CENTER ” Practice Location

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