# WK KINNEBREW AND JOHNSON CLINIC

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

## Provider details

- **NPI number:** 1902085186
- **Authorized official:** GREG J. GAVIN (NETWORK ADMINISTRATOR)
- **Authorized official phone:** (318) 212-4232

## Contact information

- **Practice address:** 2508 BERT KOUNS LOOP STE 102, SHREVEPORT, LA 71118-3175
- **Practice address phone:** (318) 688-6630
- **Practice address fax:** (318) 688-6014
- **Mailing address:** 2508 BERT KOUNS LOOP STE 102, SHREVEPORT, LA 71118-3175
- **Mailing address phone:** (318) 688-6630
- **Mailing address fax:** (318) 688-6014

## Taxonomy

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

## Other

- **Enumeration date:** 10/24/2007
- **Last updated:** 06/08/2012