Individual
JOHN KEVIN NETTERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ONE ST MARY PLACE, SHREVEPORT, LA 71101
(318) 681-4500
(318) 681-4177
Mailing address
10326 GOLDSBERRY, SHREVEPORT, LA 71106
(318) 798-0998
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
12640R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1541800
—
LA
Enumeration date
05/26/2006
Last updated
07/08/2007
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