Healthcare Provider Details

I. General information

NPI: 1770399107
Provider Name (Legal Business Name): ARZERIA L WILKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6003 FINANCIAL PLZ STE T
SHREVEPORT LA
71129-2670
US

IV. Provider business mailing address

6003 FINANCIAL PLZ STE T
SHREVEPORT LA
71129-2670
US

V. Phone/Fax

Practice location:
  • Phone: 318-606-5903
  • Fax: 318-635-3298
Mailing address:
  • Phone: 318-606-5903
  • Fax: 318-635-3298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: