Provider Demographics
NPI:1588476022
Name:WK RHEUMATOLOGY PIERREMONT
Entity type:Organization
Organization Name:WK RHEUMATOLOGY PIERREMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-716-4939
Mailing Address - Street 1:8001 YOUREE DR STE 720
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2336
Mailing Address - Country:US
Mailing Address - Phone:318-212-3833
Mailing Address - Fax:318-212-3841
Practice Address - Street 1:8001 YOUREE DR STE 720
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2336
Practice Address - Country:US
Practice Address - Phone:318-212-3833
Practice Address - Fax:318-212-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty