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Organization
WK FREDERICK AND BRAUD CLINIC
Active
Organization
WK FREDERICK AND BRAUD CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED T BEVILLE (VP - WK PHYSICIAN NETWORK)
(318) 716-4891
Entity
Organization
Contact information
Practice address
2508 BERT KOUNS LOOP, SUITE 102, SHREVEPORT, LA 71118-3133
(318) 212-5777
(318) 212-5888
Mailing address
2508 BERT KOUNS LOOP, SUITE 102, SHREVEPORT, LA 71118-3133
(318) 212-5777
(318) 212-5888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Enumeration date
11/20/2007
Last updated
06/02/2025
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