MEDICARE: MARCIA LANKFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse	RN068009	LA

General Provider Information

NPI Number	:	1124967989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA LANKFORD

Provider Business Mailing Address
First Line	:	1602 KINGS HWY RM WCC 1175
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4128
Country	:	US
Telephone Number	:	318-626-0889
Fax Number	:	318-399-6059

Provider Business Practice Location Address
First Line	:	1602 KINGS HWY RM WCC 1175
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4128
Country	:	US
Telephone Number	:	318-626-0889
Fax Number	:	318-399-6059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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