Healthcare Provider Details

I. General information

NPI: 1932106952
Provider Name (Legal Business Name): KAREN ADELINE PURDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/16/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 ALKAY DR
SHREVEPORT LA
71118-2509
US

IV. Provider business mailing address

2715 ALKAY DR
SHREVEPORT LA
71118-2509
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-8951
  • Fax: 318-212-6752
Mailing address:
  • Phone: 318-212-8951
  • Fax: 318-212-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD.018977
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.018977
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: