Healthcare Provider Details

I. General information

NPI: 1245177245
Provider Name (Legal Business Name): WK PRIMARY CARE RUSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W MISSISSIPPI AVE
RUSTON LA
71270-4202
US

IV. Provider business mailing address

PO BOX 829
RUSTON LA
71273-0829
US

V. Phone/Fax

Practice location:
  • Phone: 318-399-7130
  • Fax: 318-399-7139
Mailing address:
  • Phone: 318-399-7130
  • Fax: 318-399-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY JANE WARD
Title or Position: SENIOR VP, FINANCE
Credential:
Phone: 318-716-4939