# WK COMMUNITY HEALTH CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558393371
- **Authorized official:** GREG J GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 221-1001

## Contact information

- **Practice address:** 4700 SHREVEPORT BLANCHARD HWY, SHREVEPORT, LA 71107-4702
- **Practice address phone:** (318) 221-1001
- **Practice address fax:** (318) 221-1044
- **Mailing address:** 1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
- **Mailing address phone:** (318) 221-1001
- **Mailing address fax:** (318) 221-1044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 06/08/2012