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General NPI Number Information
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NPI Number | 1518353671
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Entity Type | Individual
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Provider Name | REBECCA ELIZABETH PISTORIUS MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1111 LINE AVE FL 3
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City | SHREVEPORT
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State | LA
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Zip | 71101-3841
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Country | US
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Telephone | 318-716-4610
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Fax | 318-716-4690
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Provider Business Mailing Address
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Address Line | 1111 LINE AVE FL 3
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City | SHREVEPORT
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State | LA
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Zip | 71101-3841
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Country | US
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Telephone | 318-716-4610
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Fax | 318-716-4690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101287189
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 322141
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 322141
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License Number State | LA
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