MEDICARE: MR. RODERICKUS WILLIAMS NP

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	163W00000X	Registered Nurse	146918	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	221798	LA

General Provider Information

NPI Number	:	1679965610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RODERICKUS WILLIAMS NP

Provider Business Mailing Address
First Line	:	9542 LUCIEN WAY
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-3432
Country	:	US
Telephone Number	:	318-455-2898
Fax Number	:

Provider Business Practice Location Address
First Line	:	8930 BAYONNE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-2033
Country	:	US
Telephone Number	:	318-455-2898
Fax Number	:

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

Provider Enumeration Date	:	02/27/2015
Last Update Date	:	08/14/2021

Similar Medicare Providers

1184188435 — KENNETH CHARLES DEAN COTA/L
Practice Location Address:

8924 BAYONNE DR
SHREVEPORT, LA
71118-2033

Practice Phone: 318-294-1952
Practice Fax:

1144970096 — LISA DIANE JOHNSON
Practice Location Address:

1812 JEWELLA AVE APT 3203
SHREVEPORT, LA
71109-2033

Practice Phone: 318-759-9405
Practice Fax:

1033111240 — SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION
Practice Location Address:

9308 MANSFIELD RD , STE 100
SHREVEPORT, LA
71118-3134

Practice Phone: 318-687-6266
Practice Fax: 318-683-1023

1861496770 — CLINT M CORMIER MD
Practice Location Address:

2508 BERT KOUNS INDUSTRIAL LOOP STE 210
SHREVEPORT, LA
71118-3175

Practice Phone: 318-212-5860
Practice Fax: 318-212-5865

1346244209 — DR. RICHARD M HARRELL MD
Practice Location Address:

2508 BERT KOUNS INDUSTRIAL LOOP STE 200
SHREVEPORT, LA
71118-3166

Practice Phone: 318-212-5044
Practice Fax: 318-212-5049

1861496556 — DR. DANIEL R KNIGHT MD
Practice Location Address:

2533 BERT KOUNS INDUSTRIAL LOOP STE 106
SHREVEPORT, LA
71118-3158

Practice Phone: 318-716-1705
Practice Fax: 318-716-1709

Directions to “ MR. RODERICKUS WILLIAMS NP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.