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General NPI Number Information
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NPI Number | 1992375844
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Entity Type | Organization
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Legal Business Name | WK ACADEMIC MEDICINE CLINIC
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 2751 ALBERT L BICKNELL DR STE 2D
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City | SHREVEPORT
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State | LA
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Zip | 71103-3939
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Country | US
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Telephone | 318-212-4232
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Fax | 318-212-4257
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Provider Business Mailing Address
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Address Line | 2751 ALBERT L BICKNELL DR STE 2D
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City | SHREVEPORT
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State | LA
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Zip | 71103-3939
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Country | US
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Telephone | 318-212-4232
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Fax | 318-212-4257
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Authorized Official
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Title or Position | REVENUE CONTRACT MANAGER
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Name | MATHEW WHEELER
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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