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SOUTHERN PEDIATRIC CLINIC
NPI 1508237256
Clinic/Center - Primary Care in Shreveport, LA

Active since October 07, 2015
4571 N MARKET ST, SHREVEPORT, LA 71107(318) 934-0097 Get Directions Write a Review

NPPES record last updated: October 7, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southern Pediatric Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN PEDIATRIC CLINIC (NPI 1508237256) is a healthcare organization registered as a primary care in Shreveport, Louisiana and active in the NPI registry since October 2015. The organization lists Stella Grace Immanuel, Md, as its authorized official.

NPPES Registry Identity

NPI1508237256
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameSOUTHERN PEDIATRIC CLINIC
Location Address4571 N MARKET STShreveport, LA 71107-2917
Mailing Address4571 N Market StShreveport, LA 71107-2917 · (318) 934-0097
Phone(318) 934-0097
Organization SubpartNo
Authorized OfficialStella Grace ImmanuelMd · (318) 730-9760
Enumeration DateOctober 7, 2015
✔ NPI 1508237256 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
License✔ Licensed in LA · MD12866R
4571 N MARKET ST, Shreveport, LA 71107
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRITTANY LUKE
Case Manager/Care Coordinator
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735
SYDNEE ASHTON MILLER LMSW
Social Worker
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 429-6938
BRIGHTER FUTURE COUNSELING SERVICES, LLC
Community/Behavioral Health
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735
TANGELA MARIE BETFORD PLMSW
Social Worker
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735
MARSHA KELLUM
Case Manager/Care Coordinator
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735
CORSICA C CARROLL
Counselor (Mental Health)
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735
TAMIA BROWN
Case Manager/Care Coordinator
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735
CRYSTAL TASBY
Case Manager/Care Coordinator
4571 N MARKET ST
SHREVEPORT, LA 71107
Caddo Parish (318) 424-8735

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Pediatric Clinic's NPI number?

The NPI number for Southern Pediatric Clinic is 1508237256. It was assigned to this organization in the NPPES registry on October 7, 2015.

Where is Southern Pediatric Clinic located?

Southern Pediatric Clinic is located at 4571 N Market St, Shreveport, LA 71107. The listed phone number is (318) 934-0097.

What is Southern Pediatric Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

When was this NPI record last updated?

The NPPES record for Southern Pediatric Clinic was last updated on October 7, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.