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General NPI Number Information
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NPI Number | 1245177245
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Entity Type | Organization
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Legal Business Name | WK PRIMARY CARE RUSTON
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 310 W MISSISSIPPI AVE
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City | RUSTON
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State | LA
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Zip | 71270-4202
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Country | US
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Telephone | 318-399-7130
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Fax | 318-399-7139
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Provider Business Mailing Address
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Address Line | PO BOX 829
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City | RUSTON
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State | LA
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Zip | 71273-0829
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Country | US
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Telephone | 318-399-7130
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Fax | 318-399-7139
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Authorized Official
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Title or Position | SENIOR VP, FINANCE
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Name | MARY JANE WARD
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Credential |
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Telephone | 318-716-4939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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