# WK PINES ROAD FAMILY MEDICINE

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

## Provider details

- **NPI number:** 1629210042
- **Authorized official:** MARY J. WARD (SR VP FINANCE)
- **Authorized official phone:** (318) 716-4939

## Contact information

- **Practice address:** 9111 SUSAN DR, SHREVEPORT, LA 71118-3136
- **Practice address phone:** (318) 212-5969
- **Practice address fax:** (318) 212-5979
- **Mailing address:** 9111 SUSAN DR, SHREVEPORT, LA 71118-3136
- **Mailing address phone:** (318) 212-5969
- **Mailing address fax:** (318) 212-5979

## Taxonomy

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

## Other

- **Enumeration date:** 03/31/2009
- **Last updated:** 03/05/2026