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General NPI Number Information
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NPI Number | 1861372633
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Entity Type | Organization
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Legal Business Name | WKH PHYSICAL MEDICINE PHYSICIANS
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1111 LINE AVE
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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 | 318-716-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 LINE AVE
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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 | 318-716-4950
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Fax |
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Authorized Official
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Title or Position | VP PHYSICIAN NETWORK
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Name | JARED THOMAS 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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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