Organization
PROGRESSIVE CHILDRENS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA KAMPERT M.D (OWNER)
(318) 828-2210
Entity
Organization
Contact information
Practice address
1919 FAIRFIELD AVE, SHREVEPORT, LA 71101
(318) 828-2210
(318) 828-2215
Mailing address
1919 FAIRFIELD AVE, SHREVEPORT, LA 71101
(318) 828-2210
(318) 828-2215
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2195719
—
LA
Enumeration date
02/13/2012
Last updated
06/28/2019
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