Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

643 EXTENDERS LLC
NPI 1821904863
Physician Assistant - Surgical in Shreveport, LA

Q: What is 643 Extenders LLC's NPI number?

The NPI number for 643 Extenders LLC is 1821904863. It was assigned to this organization in the NPPES registry on August 20, 2026.

Q: What is 643 Extenders LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Q: When was this NPI record last updated?

The NPPES record for 643 Extenders LLC was last updated on August 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 days 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.

Active since August 20, 2026

1500 LINE AVE STE 204, SHREVEPORT, LA 71101(318) 629-5496 Get Directions Write a Review

NPPES record added: August 20, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About 643 Extenders Llc NPPES

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

643 EXTENDERS LLC (NPI 1821904863) is a healthcare organization registered as a surgical in Shreveport, Louisiana and active in the NPI registry since August 2026. The organization lists John David Googe, President, as its authorized official.

NPPES Registry Identity

NPI1821904863

Entity TypeOrganization

Primary Taxonomy363AS0400X

Legal Business Name643 EXTENDERS LLC

Location Address1500 LINE AVE STE 204Shreveport, LA 71101-4648

Mailing Address717 Crockett StShreveport, LA 71101-3605 · (318) 629-5496

Phone(318) 629-5496

Organization SubpartNo

Authorized OfficialJohn David GoogePresident · (318) 629-5496

Enumeration DateAugust 20, 2026

NPPES CertifiedAugust 19, 2026

✔ NPI 1821904863 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AS0400X

1500 LINE AVE STE 204, Shreveport, LA 71101

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

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

JOSEPH R. TYNES MD

Internal Medicine

1500 LINE AVE STE 204
SHREVEPORT, LA 71101

Caddo Parish (318) 300-4926

PAUL TAYLOR GUIDRY M.D.

Internal Medicine

1500 LINE AVE STE 204
SHREVEPORT, LA 71101

Caddo Parish (318) 300-4926

DR. RICHARD JAMES MICHAEL MD

Internal Medicine

1500 LINE AVE STE 204
SHREVEPORT, LA 71101

Caddo Parish (318) 300-4926

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 643 Extenders LLC's NPI number?

The NPI number for 643 Extenders LLC is 1821904863. It was assigned to this organization in the NPPES registry on August 20, 2026.

Where is 643 Extenders LLC located?

643 Extenders LLC is located at 1500 Line Ave Ste 204, Shreveport, LA 71101. The listed phone number is (318) 629-5496.

What is 643 Extenders LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for 643 Extenders LLC was last updated on August 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 days 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.