Organization
SOUTH SHREVEPORT FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON CHARLES BARNES FNP (FNP)
(318) 349-6728
Entity
Organization
Contact information
Practice address
8660 FERN AVE STE 105, SHREVEPORT, LA 71105-5657
(318) 797-0009
(318) 797-0092
Mailing address
530 RED BARON DR, SHREVEPORT, LA 71115-3052
(318) 349-6728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1131831
—
LA
Enumeration date
10/29/2010
Last updated
10/05/2022
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