Individual
MRS. KELLY ANN WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
222 COUNTRY CLUB DR, BENTON, LA 71006-9463
(318) 965-4798
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
270221
LA
Other
Enumeration date
06/27/2007
Last updated
07/08/2007
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