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General NPI Number Information
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NPI Number | 1801137906
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Entity Type | Organization
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Legal Business Name | WKP ARKLATEX UROLOGY CLINIC
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 8001 YOUREE DR STE 820
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City | SHREVEPORT
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State | LA
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Zip | 71115-2352
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Country | US
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Telephone | 318-212-3569
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Fax | 318-212-2868
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Provider Business Mailing Address
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Address Line | 8001 YOUREE DR STE 820
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City | SHREVEPORT
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State | LA
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Zip | 71115-2352
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Country | US
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Telephone | 318-212-3569
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Fax | 318-212-2868
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Authorized Official
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Title or Position | VP PHYSICIAN NETWORK
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Name | JARED T. BEVILLE
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Credential |
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Telephone | 318-716-4891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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