Healthcare Provider Details

I. General information

NPI: 1326882754
Provider Name (Legal Business Name): KAMARIE LEANN CHILDS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GREENWOOD RD STE A
SHREVEPORT LA
71103-4010
US

IV. Provider business mailing address

2006 WOODBERRY AVE
SHREVEPORT LA
71106-8565
US

V. Phone/Fax

Practice location:
  • Phone: 318-841-5800
  • Fax: 318-841-5817
Mailing address:
  • Phone: 318-773-5531
  • Fax: 318-841-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number236031
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: