Healthcare Provider Details

I. General information

NPI: 1922533637
Provider Name (Legal Business Name): WK ALLERGY ASTHMA & IMMUNOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 BERT KOUNS INDUSTRIAL LOOP STE 112
SHREVEPORT LA
71118-3153
US

IV. Provider business mailing address

2530 BERT KOUNS INDUSTRIAL LOOP STE 112
SHREVEPORT LA
71118-3153
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-8780
  • Fax: 318-212-5994
Mailing address:
  • Phone: 318-212-8780
  • Fax: 318-212-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY J WARD
Title or Position: SENIOR VP OF FINANCE
Credential:
Phone: 318-716-4937