Individual
KEISHA ROICHELLE BONYFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103
(318) 795-2638
Mailing address
1501 KINGS HIGHWAY, ATTN: LEISA OGLESBY (RM. 1-201), SHREVEPORT, LA 71103-4228
(318) 675-4881
(318) 675-5069
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
AP09681
LA
363L00000X
Nurse Practitioner
Primary
APO9681
LA
Other
Enumeration date
04/26/2018
Last updated
06/29/2018
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