MEDICARE: REBECCA ELIZABETH PISTORIUS MD

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
1	2084P0800X	Psychiatry Physician	0101287189	VA
2	2084P0800X	Psychiatry Physician	322141	LA
3	2084P0800X	Psychiatry Physician	25IA12964900	NJ
4	2084P0804X	Child & Adolescent Psychiatry Physician	322141	LA

General Provider Information

NPI Number	:	1518353671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ELIZABETH PISTORIUS MD

Provider Business Mailing Address
First Line	:	1111 LINE AVE FL 3
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3841
Country	:	US
Telephone Number	:	318-716-4610
Fax Number	:	318-716-4690

Provider Business Practice Location Address
First Line	:	1111 LINE AVE FL 3
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-3841
Country	:	US
Telephone Number	:	318-716-4610
Fax Number	:	318-716-4690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2015
Last Update Date	:	02/12/2026

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