Provider Demographics
NPI:1689221020
Name:WK CHILDRENS HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:WK CHILDRENS HEALTH SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-212-8951
Mailing Address - Street 1:2032 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2123
Mailing Address - Country:US
Mailing Address - Phone:318-698-0035
Mailing Address - Fax:318-698-0078
Practice Address - Street 1:2032 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2123
Practice Address - Country:US
Practice Address - Phone:318-698-0035
Practice Address - Fax:318-698-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty