| Wk Pierremont Neurology Clinic | |
|
1811 E Bert Koun Loop Ste 120 Shreveport LA 71105-5741 | |
| (318) 212-2720 | |
| Not Available |
| Full Name | Wk Pierremont Neurology Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1811 E Bert Koun Loop Ste 120, Shreveport, Louisiana |
| Authorized Official Name and Position | Mary Jane Ward (SENIOR VP FINANCE) |
| Authorized Official Contact | 3182128299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wk Pierremont Neurology Clinic 1202 Louisiana Ave Shreveport LA 71101-3910 Ph: () - | Wk Pierremont Neurology Clinic 1811 E Bert Koun Loop Ste 120 Shreveport LA 71105-5741 Ph: (318) 212-2720 |
| NPI Number | 1790390995 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 09/14/2020 |
| Certification Date | 09/14/2020 |
| Medicare PECOS PAC ID | 4082033287 |
|---|---|
| Medicare Enrollment ID | O20201007000223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790390995 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | James B Pinkston |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609809912 PECOS PAC ID: 5991691990 Enrollment ID: I20040226000169 |
| Provider Name | Meghan Harris |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1235349812 PECOS PAC ID: 1153473681 Enrollment ID: I20090715000137 |
| Provider Name | Chaitanya V Amrutkar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629451638 PECOS PAC ID: 6406143064 Enrollment ID: I20200925000517 |
| Provider Name | Dmitri Aleksenko |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255718946 PECOS PAC ID: 7719274422 Enrollment ID: I20201130001127 |
| Provider Name | Wendy E Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538752407 PECOS PAC ID: 9234539339 Enrollment ID: I20210610003057 |
| Provider Name | Ramsha Malik |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043662984 PECOS PAC ID: 4789043092 Enrollment ID: I20230705002518 |
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