Healthcare Provider Details

I. General information

NPI: 1497664635
Provider Name (Legal Business Name): LAKETRA LYNETTE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 LINE AVE
SHREVEPORT LA
71101-4612
US

IV. Provider business mailing address

408 GRAVOIS DR
SHREVEPORT LA
71106-6902
US

V. Phone/Fax

Practice location:
  • Phone: 318-677-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN102416
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: