Organization
WILLIS KNIGHTON MEDICAL CENTER INC. CRNA GROUP
Active
Organization
WILLIS KNIGHTON MEDICAL CENTER INC. CRNA GROUP
Active
Other names
Willis Knighton Anesthesia Services
Organization subpart
No
Provider details
NPI number
Authorized official
STACY H ALEXANDER (CONTROLLER)
(318) 212-4877
Entity
Organization
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4877
Mailing address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1441058
—
LA
Enumeration date
07/25/2006
Last updated
11/08/2012
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