Healthcare Provider Details

I. General information

NPI: 1922837640
Provider Name (Legal Business Name): WHITNEY PLUNKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 COTY ST
SHREVEPORT LA
71101-4971
US

IV. Provider business mailing address

4830 LINE AVE STE 120
SHREVEPORT LA
71106-1530
US

V. Phone/Fax

Practice location:
  • Phone: 318-987-4808
  • Fax:
Mailing address:
  • Phone: 318-987-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-1009
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: