Individual
LETATIA VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2533 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71118-3158
(318) 686-3770
(318) 686-3838
Mailing address
2533 BERT KOUNS INDUSTRIAL LOOP STE 106, SHREVEPORT, LA 71118-3158
(318) 686-3770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10561
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1036417
NCCPA CERTIFICATION
—
Enumeration date
06/01/2015
Last updated
07/24/2024
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