Individual
JACQUELINE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6929 LAVENDER ST, SHREVEPORT, LA 71109-8335
(318) 946-7286
Mailing address
6929 LAVENDER ST, SHREVEPORT, LA 71109-8335
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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