Healthcare Provider Details

I. General information

NPI: 1487529277
Provider Name (Legal Business Name): SAMANTHA WALTERS SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BERT KOUNS INDUSTRIAL LOOP STE 215
SHREVEPORT LA
71118-3119
US

IV. Provider business mailing address

2510 BERT KOUNS INDUSTRIAL LOOP STE 215
SHREVEPORT LA
71118-3119
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-5970
  • Fax: 318-212-5975
Mailing address:
  • Phone: 318-212-5970
  • Fax: 318-212-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number213109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: