643 Extenders LLC
Physician Assistant, Surgical in Shreveport, LA. Organization (NPI-2).
NPI number1821904863
StatusActive
Last updated in NPPESAug 20, 2026
Details
- NPI
- 1821904863
- Entity type
- Organization (NPI-2)
- Legal business name
- 643 Extenders LLC
- Organization subpart
- No
- Enumeration date
- Aug 20, 2026
- Certification date
- Aug 19, 2026
- Last updated
- Aug 20, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | – | – | Yes |
Practice location
1500 Line Ave Ste 204Shreveport, LA 71101-4648
Phone 318-629-5496
Mailing address
717 Crockett StShreveport, LA 71101-3605
Phone 318-629-5496
Authorized official
John David Googe
President
3186295496
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