Healthcare Provider Details

I. General information

NPI: 1669441671
Provider Name (Legal Business Name): SHANNON DAWN SPIGENER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 HOMER RD
MINDEN LA
71055-3027
US

IV. Provider business mailing address

1611 GERMANTOWN RD
MINDEN LA
71055-1301
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-7500
  • Fax: 318-377-2324
Mailing address:
  • Phone: 318-377-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.022110
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLA022110
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: