Basic Information
| Provider Information | |||||||||
| NPI: | 1932106952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURDY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ADELINE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2715 ALKAY DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711182509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128951 | ||||||||
| FaxNumber: | 3182126752 | ||||||||
| Practice Location | |||||||||
| Address1: | 2715 ALKAY DR | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711182509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182128951 | ||||||||
| FaxNumber: | 3182126752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD.018977 | LA | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | MD.018977 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080157229 | 01 | TN | RAILROAD MEDICARE | OTHER | 140376 | 01 | UNITED HEALTHCARE | OTHER | 3147088 | 01 | TN | BCBS | OTHER | 3851650 | 05 | TN | MEDICAID | 96964 | 01 | AR | BCBS | OTHER | 148975 | 05 | AL | MEDICAID | 00114317 | 05 | MS | MEDICAID | 2708986 | 01 | CIGNA | OTHER | 1726672 | 05 | LA | MEDICAID |