Organization
WK PINES ROAD FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY J. WARD (SR VP FINANCE)
(318) 716-4939
Entity
Organization
Contact information
Practice address
9111 SUSAN DR, SHREVEPORT, LA 71118-3136
(318) 212-5969
(318) 212-5979
Mailing address
9111 SUSAN DR, SHREVEPORT, LA 71118-3136
(318) 212-5969
(318) 212-5979
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1954306
—
LA
Enumeration date
03/31/2009
Last updated
03/05/2026
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