Basic Information
| Provider Information | |||||||||
| NPI: | 1114924404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCFERREN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1811 E BERT KOUNS INDUSTRIAL LOOP STE 120 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182122720 | ||||||||
| FaxNumber: | 3182122718 | ||||||||
| Practice Location | |||||||||
| Address1: | 1811 E BERT KOUNS INDUSTRIAL LOOP STE 120 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182122720 | ||||||||
| FaxNumber: | 3182122718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | A10356 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.